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Medicare/Medicaid EHR Incentive Programs

There are two incentive payment programs outlined under the HITECH Act—one through Medicare and another from Medicaid. Providers can only submit for payment of an incentive bonus from one of these programs, so they will need to analyze their organization’s public payer mix to determine where they stand to benefit the most. Both programs require that a provider prove “Meaningful Use” of a certified EHR product (e.g. WEBeDoctor EMR) to qualify for these financial incentives.

Click Here to determine which program you are eligible for.

Government stimulus payments that help physicians purchase electronic health record (EHR) software should create tremendous efficiencies and quality of care improvements in the public health sector. The rules for qualifying for the payments are necessarily complex and full of checks and balances—this helps mitigate the risk of scammers abusing EHR systems.

While some EHR vendors’ guarantee reimbursement to providers in the case that their software fails to meet the government’s regulations, they still leave their providers trained on a piece of software that doesn’t meet current U.S. government healthcare requirements. Therefore, it is imperative to choose a vendor that has a track record of successfully meeting industry requirements and standards.

The deadline for obtaining an EHR and showing “Meaningful Use” for the 2012 incentive year is October 1st. You must have an EHR system in place and you must show Meaningful Use for a period of 90 days in 2012 (if it is your first reporting year). Therefore the last attestation period of 2012 is October 1st through December 31st. Get started with WEBeDoctor’s EHR today and one of our Product Specialist’s can assist you and your practice in implementing and meeting the Meaningful Use standards.

What is Meaningful Use?

Meaningful Use requirements were released by the U.S. government on July 13, 2010. The final rule definitively outlines all the specifics of Stage 2 Meaningful Use, and also details what type of clinical quality measure reporting structure providers need to have in order to receive the incentive payments in 2013.

The Recovery Act specifies three main components of Meaningful Use:

  • The use of a certified EHR in a meaningful manner (e.g.: e-Prescribing)
  • The use of certified EHR technology for electronic exchange of health data to improve quality of health care
  • The use of certified EHR technology to submit clinical quality and other measures

The definition of Meaningful Use harmonizes criteria across CMS programs as much as possible and coordinates with existing CMS quality initiatives. It also closely links to the certification standards criteria in development by the Office of the National Coordinator (ONC) and provides a platform for a staged implementation over time.

What are the Specifics of Stage 1 Meaningful Use? (2011 and 2012)

Meaningful Use includes both a core set and a menu set of objectives that are specific for eligible professionals and hospitals. For Eligible Professionals, there are a total of 25 objectives. 20 of the objectives must be completed to qualify for an incentive payment. 15 are core objectives that are required, and the remaining 5 objectives may be chosen from the list of 10 menu set objectives. To realize improved health care quality, efficiency and patient safety, the criteria for Meaningful Use will be staged in three steps over the course of the next five years. Stage 1 sets the baseline for electronic data capture and information sharing. Stage 2 and Stage 3 (est. 2015) will continue to expand on this baseline and be developed through future rule making by the U.S.

To find out how you can meet these measures of Meaningful Use from WEBeDoctor, check out our Meaningful Use Cheat Sheet.

As a physician, what if I don’t demonstrate use of an EHR after the incentives are in place?

Beginning in 2015, physicians not demonstrating Meaningful Use will have their Medicare fee schedule reduced.

Reductions will be:

  • For 2015, down to 99% of the regular fee schedule
  • For 2016, down to 98%
  • For 2017 and each subsequent year, down to 97%

If the Secretary finds that less than 75% of eligible healthcare professionals are utilizing EHR beginning in 2018, the Secretary can further reduce the fee schedule to 96% and then 95% in subsequent years but not further.

Can I receive Stimulus funds and incentives for PQRS and ePrescribing at the same time?

Eligible Providers receiving bonuses for meeting Meaningful Use requirements are eligible to participate in the PQRS Program simultaneously. Because ePrescribing is a requirement of Meaningful Use, providers cannot receive ePrescribe incentives in the same year in which they receive Medicare Stimulus funds. However, those receiving Medicaid Stimulus funds are eligible to participate in all three programs simultaneously.

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Get Paid to Go Paperless

The U.S. government has set aside billions of dollars in the American Recovery and Reinvestment Act (ARRA) for eligible providers (EPs) in order to promote conversion to an EHR system. The ARAA also outlines penalties for practices that don’t convert to an EHR. Now is the time for your practice to adopt WEBeDoctor’s integrated EMR and Practice Management solution.

Medical practices that implement an EHR early benefit the most. Here’s why.

There are three stages of Meaningful Use requirements that EPs must satisfy to be paid. Each stage will exhibit more stringent requirements than the prior stage (i.e. Stage 1 is easier than Stage 2; Stage 2 is easier than Stage 3). The table below shows the payments for EPs who submit under the Medicare plan. There is a higher payout table for EPs such as pediatricians or others with large Medicaid patient populations who elect to submit under the Medicaid plan. Call us for details toll-free at 1-877-904-0038.

Implement Meaningful Use Stage / Payment Amount Under the Medicare Plan
2011 2012 2013 2014 2015 2016 Total
2011 Stage 1/ $18,000 Stage 1/ $12,000 Stage 2/ $8,000 Stage 2/ $4,000 Stage 3/ $2,000 $44,000
2012 Stage 1/ $18,000 Stage 1/ $12,000 Stage 2/ $8,000 Stage 2/ $4,000 Stage 3/ $2,000 $44,000
2013 Stage 1/ $15,000 Stage 2/ $12,000 Stage 3/ $8,000 Stage 3/ $4,000 $39,000
2014 Stage 1/ $12,000 Stage 3/ $8,000 Stage 3/ $4,000 $24,000

So, practices that implement an EHR in 2010 get the following benefits: Since payments under the Medicare formula are based on the EPs’ Medicare billings, the more time the provider has to see Medicare patients, the greater the chance the provider will be able to receive the maximum payments shown. Second, they’ll have the least onerous “Stage” criteria to meet. In the chart, you’ll notice that they’ll have two times to attest to Meaningful Use in the Stage One category, two in Stage Two and one in the most stringent, Stage Three. Waiting changes the burden – two Stage 3 requirements that would have to be met to receive the same $44,000. In short, if you’re going to purchase an EHR, don’t wait!