EMR Stimulus Incentive- Common Questions:
We have been told that the US Government Incentives are there for providers who implement an EMR- but what exactly does that mean? Look below for common questions and answers to get a better understanding of who and what qualifies for these funds.
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What is the potential financial benefit of the healthcare IT incentives to physicians?
Each office-based physician who meaningfully uses a certified EHR could receive up to $44,000 (Medicare) or $64,000 (Medicaid) in government funding. Office-based physicians practicing in rural or underserved areas would be eligible for up to an additional $4,400 in Medicare incentives. These figures represent the maximum allowable incentives under the Medicare and Medicaid programs. Physicians may only qualify for either the Medicare or the Medicaid funding, but cannot qualify for both.
Who qualifies as an eligible professional?
“Eligible professionals” under the Medicare HIT incentive program are limited to physicians as defined in the Social Security Act (§1861(r)), which includes:
• A doctor of medicine or osteopathy
• A doctor of surgery or of dental medicine
• A doctor of podiatric medicine
• A doctor of optometry
• A chiropractor
To receive Medicare incentive payments, the physician must:
• Not be hospital-based;
• Demonstrate meaningful use of a certified EHR; and
• Submit Medicare Part B claims of at least 133% of the maximum incentive for a program year to qualify for the maximum incentive payment.
The Medicaid HIT Incentive program expands the definition of “eligible professionals” to include:
• Certified nurse mid-wife
• Nurse practitioner
• Physician assistant (under certain circumstances)
To receive Medicaid incentive payments, eligible professionals must:
• Not be hospital-based;
• Demonstrate meaningful use of a certified EHR; and
• Treat a patient population, of which at least 30% receive medical assistance (or 20% if the physician is a pediatrician).
Although the incentives are not dependent on the eligible provider being a participating Medicare provider, the incentive amounts available to any provider is the lesser of 133% of their annual billed Medicare Part B charges or the maximum payment specified for the year in the regulations. (For example, a provider would have to bill $16,000 in Part B charges in order to qualify for a year in which the maximum allowable incentive payment is $12,000.) There are no distinctions between specialty and primary care physicians in terms of the incentives, EXCEPT that hospital-based physicians do not qualify for the physician incentives.
What is meant by “meaningful use” of healthcare IT?
Funding and incentives are tied to “meaningful” use. While no one yet knows the full definition of meaningful use, preliminary descriptions include the following:
An eligible professional shall be treated as a meaningful EHR user for a reporting period for a payment year if the following requirements are met:
• Meaningful use of certified EHR technology. The eligible professional demonstrates to the satisfaction of the HHS Secretary, that during such period the physician is using certified EHR technology in a meaningful manner. The certified EHR shall include the use of electronic prescribing as determined to be appropriate by the HHS Secretary.
• Information exchange. The eligible professional demonstrates to the satisfaction of the HHS Secretary that during such period such certified EHR technology is connected in a manner that provides, in accordance with law and standards applicable to the exchange of information, for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination.
• Reporting of measures using EHR. Using such certified EHR technology, the eligible professional submits information for such period, in a form and manner specified by the HHS Secretary, on such clinical quality measures and such other measures as selected by the HHS Secretary. The HHS Secretary shall seek to improve the use of EHRs and healthcare quality over time by requiring more stringent measures of meaningful use selected under this paragraph.
Which EHR / EMR is certified and qualifies for stimulus money?
When will the payments be made?
Funds became available for office-based physicians on January 1, 2011. In several states checks have already been issued for those qualifiying under Medicaid. Medicare payments begin in April 2011. Physicians receive payments 4-6 weeks after attestation of Meaningful Use.
Providers should begin planning as soon as possible to allow time to achieve meaningful use of certified solutions during 2011 or 2012 if they would like to receive the maximum reimbursements.
How do I submit for reimbursement? Registration and Attestation
Registration for the Medicaid and Medicare EHR Incentive Program is now open. You can register before you have a certified EHR. Information on registration or to register.
What are the additional incentives for office-based physicians to adopt in the early years of the program?
Office-based physicians’ maximum allowable Medicare incentive for the first year of meaningful use is increased by $3,000, from $15,000 to $18,000, for meaningful EHR use in 2011 or 2012. This “early adopter” incentive raises the total amount physicians can qualify for from $41,000 to $44,000. A benefit for office-based physician early adoption does not exist under the Medicaid incentive program.
What are the penalties if physicians do not adopt an EHR/EMR?
For office-based physicians who do not adopt such technology by 2015, Medicare payments will be reduced by the following factors in the years specified:
• 2015: One percent
• 2016: Two percent
• 2017 and beyond: Three percent
• 2018 and beyond: HHS Secretary may decrease one additional percent/year (max of 5%) if 75% of office based physicians don’t adopt technology by 2018
Who qualifies for the additional 10% rural health incentive?
An “eligible professional” who predominantly furnishes services in a geographic area that is designated by the HHS Secretary as a health professional shortage area may receive a 10% increase in their annual payment.
Are incentives for new systems only or systems already in use?
The incentives are available to meaningful users of certified IT systems described in the legislation regardless of when they were implemented. The qualifier is the date at which the eligible provider can demonstrate meaningful use of the certified technology.
Who benefits from the healthcare IT incentives?
Primarily hospitals and office-based physicians will benefit from the incentives. They are designed to reduce healthcare costs by accelerating the use of IT to improve quality, safety and efficiency. Ultimately, patients and caregivers also will benefit from the automation and connectivity enabled by EHR/EMRs.
Practice Partner version 9.5, Medisoft Clinical v17, and Lytec MD 2011 recently earned certification as “Complete” electronic health record (EHR) systems under the Office of the National Coordinator (ONC) Authorized Testing and Certification Body (ATCB) process. The software was certified by the Certification Commission for Health Information Technology (CCHIT®), an ONC-ATCB, as 2011/2012 compliant in accordance with the applicable certification criteria for Eligible Providers adopted by the Secretary of Health and Human Services.* Certification was granted on December 6, 2010.
* McKesson’s Practice Partner 9.5, Medisoft Clinical v17 and Lytec 2011 are now 2011/2012 compliant and were certified as a Complete EHR on December 6, 2010, by the Certification Commission for Health Information Technology (CCHIT®), an ONC-ATCB, in accordance with the applicable certification criteria for eligible providers adopted by the Secretary of Health and Human Services. The certification number is CC-1112-589589-1. ONC-ATCB 2011/2012 certification conferred by CCHIT does not represent an endorsement of the certified EHR technology by the U.S. Department of Health and Human Services nor does it guarantee the receipt of incentive payments.
The clinical quality measures to which Practice Partner Version 9.5, Medisoft Clinical v17 and Lytec 2011 have been certified include: NQF 0421, NQF 0013, NQF 0028, NQF 0041, NQF 0024, NQF 0038, NQF 0059, NQF 0064, and NQF 0061.
The additional software that Practice Partner, Medisoft Clinical and Lytec MD relied upon to demonstrate compliance includes: Windows Server® 2008 Server which includes BitLocker® and IPSec for 170.302(u) & 170.302(v); SureScripts Messenger™ Services for 170.304(b) & 170.302(b); Medi-Span® for 170.302(e) & 170.302(a); AMA’s CPT® codes for 170.302(d), 170.304(e) & 170.304(a); and RelayClinical™ Education for 170.302(m).