WHAT IS MEANINGFUL USE AND HOW WILL IT AFFECT MY PRACTICE? CMS EHR Incentive Programs

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1 OVERVIEW WHAT IS MEANINGFUL USE AND HOW WILL IT AFFECT MY PRACTICE? CMS EHR Incentive Programs In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) provision of the American Recovery and Reinvestment Act (ARRA) was introduced into law to accelerate the adoption of electronic health record (EHR) systems among providers. ARRA FUNDING: Health Care received the largest amount. This HITECH stimulus provides nearly $19 billion over five years in the form of grants, loans and incentive payments to eligible healthcare providers. Although this act provides some new HIPAA requirements, its primary focus is the CMS (Centers for Medicare and Medicaid Services) EHR Incentive Programs. (It should be noted that the EHR Incentive Program is not related to the Healthcare Reform Act.) It is exciting to know that from inception through July 2012, CMS has paid out over $6.5 billion dollars to eligible providers and hospitals under the EHR Incentive Programs. For more details regarding these payouts, please see the Meaningful Use section of this website. Frequently, the EHR Incentive Programs and the term meaningful use or MU, are used interchangeably. Although related, they technically have a different meaning. MU is part of the overall incentive programs. The CMS EHR Incentive Programs provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. A provider does not have to purchase a new EHR to receive the incentive monies. If the current EHR is certified by the Office of the National Coordinator for Health IT (ONC) under the CMS program, it will qualify under the provision. To determine if your current EHR system is certified (you need to know the version), or to view systems before you purchase, you can review certified systems on the ONC website at: 1

2 The EHR Incentive program is based on the meaningful use of certified EHR technology. The incentive program provides the funding to adopt and utilize an EHR, and the provider must demonstrate that he/she is utilizing the EHR in a meaningful manner, following the Meaningful Use requirements. CMS has defined Meaningful Use in stages, with each stage requiring more advanced use of electronic health records: Stage 1 sets the baseline for electronic data capture and information sharing Stage 2 will focus on information exchange and quality Stage 3 will focus on improved outcomes Physicians will progress through all three stages of Meaningful Use regardless of which year they enter the program. Stage 2 of MU, which was finalized by CMS on August 23, 2012, is set to begin in 2014 and will be phased- in based upon a provider s initial attestation date. There is no proposed roll- out date for Stage 3 at this time. CMS offers two separate programs one through Medicare and the other through Medicaid. The program dollars, eligible providers and other rules vary, so they are reviewed individually below. (This website addresses items related only to professional providers, not hospitals.) Providers cannot participate in both the Medicare and Medicaid programs at the same time; they must choose one of them. They may switch from one program to another only once before The chart below identifies the differences between the two programs. 2

3 MEDICARE EHR INCENTIVE PROGRAM WHO IS ELIGIBLE? Under the Medicare program, the following types of physicians are eligible to participate in the EHR Incentive Program. Doctors of Medicine Doctors of Osteopathy Podiatrists Chiropractors Dentists (DDS and DMD) Optometrists Incentive payments for eligible professionals are based on individual practitioners. If you are part of a group practice, each eligible professional may qualify for an incentive payment if each eligible professional successfully demonstrates meaningful use of certified EHR technology. Each eligible professional is only eligible for one incentive payment per year, regardless of how many practices or locations at which he or she provides services. NOTE: Physicians who are hospital- based are not eligible for the EHR incentives. A provider is considered hospital- based if 90% or more of his or her services are performed in a hospital inpatient (place of service code 21) or emergency room (place of service code 23) setting. THE INCENTIVES AND PENALTIES The Medicare program is designed to reimburse eligible physicians at an annual amount of 75% of their Medicare physician fee schedule allowable charges, which must be submitted no later than two months after the end of the calendar year. The maximum allowance per year is outlined in the chart below. As the deadline of October 3, 2012 is nearly here for the final attestation period of 2012, any provider who has not successfully attested by that date will move to 2013 for their first year of incentive and will be entitled to a maximum of $39,000 for the program, assuming that meaningful use is successfully met each year. Please see the section on Attestation for additional information. 3

4 Based upon the above chart, a physician would have to bill Medicare a minimum of $20,000 in allowable charges to receive the $15,000 for 2013 if that is the first year of participation (75% of $20,000 = $15,000). If a provider successfully attested in 2012, then he/she would have to submit a minimum of $16,000 in allowable expenses under the Medicare fee schedule to receive the second year incentive of $12,000 in 2013 (75% of $16,000 = $12,000). Eligible physicians who predominately furnish more than 50% of their services in a Health Professional Shortage Area (HPSA) may receive an additional EHR incentive payment of 10% each year. CMS will use the frequency of services provided over a one- year period based upon a calendar year. Please refer to the CMS EHR Incentive website and their brochure for additional details. CMS will make payment adjustments as a penalty if a provider is not properly utilizing an EHR by the specified timeframe. The provision states that if an eligible provider does not successfully demonstrate meaningful use of certified EHR technology, the provider s Medicare fee schedule amount for covered professional services will be adjusted by the applicable payment adjustment beginning in 2015, as outlined in the regulations. Payment adjustments will be as follows: 2015: 99% of Medicare physician fee schedule covered amount 2016: 98% of Medicare physician fee schedule covered amount 2017 and each subsequent year: 97% of Medicare physician fee schedule covered amount Ø If it is determined that for 2018 and beyond that less than 75% of the eligible providers are meaningful users, then the payment adjustment will change by one percentage point each year until the payment adjustment reaches 95%. There are a few hardship exceptions and those are briefly discussed in the Meaningful Use section. Providers who receive incentives under the Medicare EHR program will be able to receive incentives under the PQRS program, providing they qualify. However, they will not be able to receive monies under the erx program. Medicare Advantage Incentive Payments ARRA provides for incentive payments to qualifying Medicare Advantage organizations (MAO) for their affiliated EPs (eligible professionals) who are meaningful users of certified EHR technology. Any such eligible payments would be made to the MAO, and not the individual provider. Please refer to the CMS website for more details. The CMS User Guide for the Medicare EHR program can be found on the CMS website: and- Guidance/Legislation/EHRIncentivePrograms/downloads/EP_Attestation_User_Guide.pdf 4

5 REGISTRATION AND ATTESTATION Eligible providers who desire to participate in the Medicare EHR Incentive Program must first register online at the CMS website: You may register before you begin to actively use your certified EHR system. CMS allows an eligible professional to designate a third party to register and attest on his or her behalf. To do so, users working on behalf of an eligible professional must have an Identity and Access Management System (I&A) web user account (User ID/Password), and be associated to the eligible professional's National Provider Identifier (NPI). Below is the link to a very detailed Medicare registration user guide you may find helpful. and- Guidance/Legislation/EHRIncentivePrograms/Downloads/EHRMedicareEP_RegistrationUserGui de.pdf Once a provider has registered and implemented a certified system, they must go through a process called attestation. To receive an incentive payment, Medicare Eligible Professionals must attest to their meaningful use of certified electronic health record technology. A provider must utilize the EHR and prove meaningful use of that application for a 90- day period for their first year. Thereafter, the Meaningful Use (MU) reporting period is a calendar year and all five years must be consecutive. The link below is for the CMS Attestation Guide. and- Guidance/Legislation/EHRIncentivePrograms/downloads/EP_Attestation_User_Guide.pdf CMS also offers an online questionnaire regarding attestation. This online tool allows providers to test whether or not they would successfully demonstrate meaningful use for the EHR Incentive Programs. Many providers have found this tool to be very helpful as they prepare for meaningful use. Below is a link to this tool. Please see the separate section on this site titled Meaningful Use for details about Stage 1 and Stage 2 requirements. MEDICAID EHR INCENTIVE PROGRAM WHO IS ELIGIBLE? Under the Medicare program, the following types of providers are eligible to participate in the EHR Incentive Program. Doctors of Medicine Doctors of Osteopathy Dentists (DDS and DMD) Nurse practitioners Certified nurse mid- wives Physician assistants (must be practicing in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant) 5

6 To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet one of the following criteria: Have a minimum 30% Medicaid patient volume* Have a minimum 20% Medicaid patient volume, and is a pediatrician* Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals * Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria. THE INCENTIVES The Medicaid program will pay eligible providers $63,750 over a six- year period based upon the schedule below. The last year providers can begin their initial year and receive the maximum incentive is There is no penalty under Medicaid for providers who fail to adopt a certified EHR. 6

7 Note: The incentive dollars for pediatricians who meet the 20% patient volume but fall short of the 30% patient volume is $14,167 in the first year and $5,667 in subsequent years. This adds up to a maximum Medicaid incentive of $42,500 over a six- year period. Providers who receive an EHR incentive payment through the Medicaid Program may also be eligible to receive an incentive through the Medicare erx Incentive Program, provided they meet all the requirements of the erx Program. Although the CMS Medicaid EHR incentive program is funded and mostly regulated by the federal government, it is managed and administered by each state. The incentive program is voluntary, so if a state chooses not to participate, then providers will not be offered a Medicaid option. Each state can determine the attestation requirements so a provider must contact his/her state agency for details. The CMS User Guide for the Medicaid EHR program can be found on the CMS website: and- Guidance/Legislation/EHRIncentivePrograms/downloads/EHRMedicaidEP_RegistrationUserGui de.pdf The Georgia Medicaid program is active and can be accessed at this site: ehr- incentives- program The Georgia website contains a complete overview of the Medicaid program, decision tool, a calculator for determining patient volume, and several other items. REGISTRATION AND ATTESTATION While all providers begin their registration through the CMS Registration & Attestation System, Medicaid eligible professionals must attest though their State Medicaid Agency s website. Some states have not yet opened their Medicaid EHR Incentive Programs, and therefore, eligible professionals (EPs) will not be able to register for a Medicaid EHR Incentive Program until their state's program has launched and that state's site has opened. Georgia has initiated its incentive program and details can be found at ehr- incentives- program. Information on other states may be found at Below is a link to a very detailed registration user guide for Medicaid you may find helpful. and- Guidance/Legislation/EHRIncentivePrograms/Downloads/EHRMedicaidEP_RegistrationUserGui de.pdf All providers register on the same CMS site whether they are participating in the Medicare or Medicaid program. Registration must occur before you can attest. The site is: Georgia also requires a separate registration and this is explained on their website. 7

8 The requirements for Medicaid attestation are different than under the Medicare program. Eligible professionals under Medicaid need only to attest to adopt, implement or upgrade to a Fully Certified Ambulatory EHR the first year. The second year you will need to report on 90 days of Meaningful Use and then years 3-6 you will need to report on 12 months. You will also need to provide financial data for proof of the 90 days of Medicaid data that shows you had 30% Medicaid clients (or 20% for pediatricians). The link below will take you to Georgia s Quick Start Guide which is a very informative tool to begin the Georgia Medicaid EHR Incentive program QuickStartGuide.pdf This guide has been compiled for the Physicians Institute by the Coker Group, a nationally recognized healthcare consulting firm. If you would like additional information or have questions regarding your specific situation regarding the EHR Incentive Program or meaning use, or if you need assistance selecting an EHR vendor, you may contact a Coker technology representative at

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