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How to Attest for Meaningful Use
SammyEHR v6.1
Use this checklist to guide you through what is needed to complete the attestation. We encourage you to perform the
attestations on your own. If you would like us to assist you, we will schedule an appointment. The fee for our
attestation assistance is $150 per provider. (The fee does not apply for 1st year attestations).
We must receive this signed checklist, waiver form, and payment before scheduling the attestation.
Is this your first year attesting for Meaningful Use?
Yes
No
How to Register/Attest on the Medicare Website
Medicare has developed very comprehensive instructions on the attestation process on their website. Links are available
by clicking through the Support Center on the upper left of your Measure Calculator in Sammy.
Please note the following:
 Attestations are done per individual NPI. The ARRA Measure report must be run
separately for each individual provider.
 If you treat patients in other locations that have certified software other than
SammyEHR, you must obtain the measure calculators and clinical quality measure
reports from those programs so you can add the numbers together. Visit the
CHPL (Certified Health Product Listing) if you did not use only SammyEHR to
achieve Meaningful Use to obtain a CMS EHR Certification ID.
 If you treat patients in other locations that do not have certified software, and
those locations make up more than 50% of your practice, you are not eligible to
attest.
 Please check off each item to acknowledge them and sign the bottom of this form
if you require our assistance with the attestation. If not, use this to guide you
through the process.
Rev 9/8/2014
Checklist and Instructions
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Your Measure Calculator version is at least v6.1.150. If not, get a Measure Calculator program update.
All of the claims for all Places of Services have been entered within the dates of service on the measure calculator.
(If you are attesting for your 1st year of Meaningful Use, the measure calculator can be set to any 90 day period after
your upgrade date to 2014. If this is your 2nd or 3rd or 4th year of Meaningful Use, it is a calendar quarter (for 2014).
All core measures are GREEN AND say “PASSED” on the right AND you have met the gray measures that apply to
you.
You are prepared to attest for 5 Menu Measures for Stage 1 and 3 Menu Measures for Stage 2. Please note: You
attest that you have used Sammy in an appropriate manner and the information you are attesting with accurately
reflects what was done at your practice.
You have completed your HIPAA RISK ANALYSIS for the current year. EPs must conduct or review a security risk
analysis of certified EHR technology and implement updates as necessary at least once prior to the end of the EHR
reporting period and attest to that conduct or review. The testing could occur prior to the beginning of the first EHR
reporting period. However, a new review would have to occur for each subsequent reporting period.
You have your PECOS login for your individual NPI number (If not, call 888-734-6433 and ask for a reset).
If you have administered immunizations within the meaningful use period, you have contacted us (e-mail
support@ICSSoftware.net) to help direct you where to obtain a login so you can send a test file to your state’s
immunization registry. (If you do not administer immunizations, disregard this).
If you are in a state that supports electronic submission of syndromic surveillance data, you have contacted us (email support@ICSSoftware.net) to help you obtain a login so you can send a test file to your state’s registry. (If you
are in a state that does not support this, disregard this).
If you have multiple Sammy datasets, you will need to run the measure calculator one time in each location and
add the numbers together. (This does not apply to you if you have a server and your different locations connect to it
and share data).
You are the billing doctor on all your claims.
Now that you have done the above, please follow the below instructions which will take you through gathering the
documentation you need from Sammy to perform the attestation.
1. Click “Utilities”, “ARRA Measure Report”. For multi-doctor practices chose doctor, and begin and end dates for your
Meaningful Use period. Then chose if you are running Stage 1 or Stage 2. Then click “Calculate” on the lower left
side of the screen.
2. Enter the number permissible prescriptions that you wrote outside of SammyEHR (this number should not include
narcotics or DME supplies).
3. Enter the number of Lab orders that will you received results for as a number or a positive or negative format.
4. When your calculations have finished Click “I am Ready to Attest”. (This button will not be available until the end
of the attestation period, and you must have already passed the required measures). Once you click on that
button, Sammy will take you through the informational screens with instructions on what to do. Please follow the
instructions. Based on what you select here, ICS will be notified if you are doing the attestation by yourself or if
you would like our assistance. We will contact you to schedule the attestation if you select the “I want ICS to help
me with my attestation”.
5. The Measure Calculator Report will automatically print after reading through the informational screens. You will
need these printouts during the attestation.
Rev 9/8/2014
6. CQM’s (Clinical Quality Measures) must be run as well. To do this got to “Utilities”, “CQM system”, choose the
doctor and the Reporting Period start and End dates. Click “Export”. Save the data in your FINANCE folder in your
data set. Print the results and have them ready for the attestation.
7. You should now have the following items in front of you:
a. Printout of the Measure Calculator
b. Printout of the Clinical Quality Measure Report
c. PECOS login information (same as the Meaningful Use Attestation website login information).
8. You are now ready to attest. If you opted to have ICS attest with you, please sign and fax us this form along with
the attestation authorization form that printed out. We will contact you to schedule the attestation appointment
as soon as we receive payment. You do not have to proceed further with these instructions.
Continue on ONLY if you are completing the attestation on your own:
9. Go to the Meaningful Use Attestation Website: https://ehrincentives.cms.gov/ (You may also access this website
from the Support Center on the upper left of the Measure Calculator).
10. Read Medicare’s instructions (Links are available www.SammyUniversity.com and in the “Support Center” on the
upper left of the Measure Calculator).
11. After the attestation has been completed, please go back to Sammy and open the Measure Calculator (click
“Utilities”, then “ARRA Measure Calculator”).
12. Click on the upper left, “Support Center” then click “I have completed my attestation”. Specify the date the
attestation was completed and click “Send this information to ICS to update my software to the next year of
Meaningful Use. You will be required to re-enter the password of the provider who attested.
You should receive your incentive payment within 4-8 weeks of the attestation. If you do not receive your payment
within that time frame, contact the EHR helpdesk for status: 888-734-6433.
__________________________________________________________________________________________
Please complete the below if you require our assistance with the attestation.
Fax to: 516-705-0320 along with the attestation waiver form.
Provider Name: _________________________________
Provider Signature: ______________________________
Provider Individual NPI: __________________________
Rev 9/8/2014
Date: ________________________________________
ICS INTERNAL USE ONLY
Save MU and CQMs to case
Attestation waiver attached/in case
Checklist attached/in case
Case Subject Updated
Attestation date entered to case
Attestation date in Admin
Invoice entered
_____ (initial)
_____ (initial)
_____ (initial)
_____ (initial)
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ATTESTATION WAIVER FORM
Practice Name _______________________________________________
Doctor’s Name _______________________________________________
Address
_______________________________________________
City, State, Zip _______________________________________________
Phone
_______________________________________________
Date: ______________________
Attention ICS Software, Ltd:
By signing below, I attest that I have used Sammy in an appropriate manner and information I am
attesting with accurately reflects what was done at my practice.
I choose to utilize your services to help me attest and walk me through the attestation step by step.
Although you are helping my office through the attestation, I am fully aware of the Meaningful Use
requirements and attest that I am responsible for all information provided to CMS during the attestation
process.
________________________________
Individual NPI Number
________________________________
Doctor Signature
_______________________________
Date Signed
Please complete this form if you require our assistance with the attestation.
Fax to: 516-705-0320 along with the checklist.
Rev 9/8/2014
ICS Software, Ltd.
3720 Oceanside Road West
Oceanside, New York 11572
Tel: 516-766-2129
Fax: 516-705-0320
E-Mail: Sales@ICSSoftware.net
www.ICSSoftware.net
Rev 9/8/2014