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

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WHAT  IS  MEANINGFUL  USE  AND  HOW  WILL  IT  AFFECT  MY  PRACTICE?  

CMS  EHR  Incentive  Programs  

OVERVIEW  

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.  

 

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http://oncchpl.force.com/ehrcert    

 

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  2015.  

 

The  chart  below  identifies  the  differences  between  the  two  programs.  

 

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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.  

 

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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.  

 

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REGISTRATION  AND  ATTESTATION    

Eligible  providers  who  desire  to  participate  in  the  Medicare  EHR  Incentive  Program  must  first  

register   online   at   the   CMS   website:    https://ehrincentives.cms.gov/hitech/login.action.     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.  

http://www.cms.gov/Regulations-­‐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.  

 

http://www.cms.gov/Regulations-­‐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.  

 

http://www.cms.gov/apps/ehr/    

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.  

 

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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  2016.    There  is  no  penalty  under  Medicaid  for  providers  who  fail  to  adopt  a  certified   EHR.  

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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:  

http://www.cms.gov/Regulations-­‐and-­‐

Guidance/Legislation/EHRIncentivePrograms/downloads/EHRMedicaidEP_RegistrationUserGui de.pdf  

 

The  Georgia  Medicaid  program  is  active  and  can  be  accessed  at  this  site:      

http://dch.georgia.gov/medicaid-­‐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   http://dch.georgia.gov/medicaid-­‐ehr-­‐ incentives-­‐program.     Information   on   other   states   may   be   found   at  

http://www.cms.gov/apps/files/statecontacts.pdf.    

Below  is  a  link  to  a  very  detailed  registration  user  guide  for  Medicaid  you  may  find  helpful.  

http://www.cms.gov/Regulations-­‐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:  

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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.  

http://dch.georgia.gov/sites/dch.georgia.gov/files/imported/vgn/images/portal/cit_1210/57/20/181500

939QuickStartGuide.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  770-­‐597-­‐0590.  

   

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