EMR and Meaningful Use
Payment Adjustments for Eligible
Professionals
who are not Users of Certified Electronic Health Records (EHR) Technology
Off-Label Use Disclosure(s)
I
do not intend
to discuss an off-label use of a product
Financial Disclosure(s)
I
have not had
any relevant financial relations during the
Overview
As part of the American Recovery and Reinvestment Act of 2009 (ARRA),
Congress mandated payment adjustments to be applied to Medicare eligible professionals who are not “Meaningful Users” of Certified Electronic Health Record Technology.
These payment adjustments will be applied beginning on January 1, 2015 The payment adjustment will be applied to the Medicare physician fee
schedule (PFS) amount for covered professional services furnished by the professional during the year.
What do the Payment Adjustments Look
Like?
Eligible Professionals receive the
payment adjustment amount that is tied to the year that they did not demonstrate MU
Ex. The professional who is eligible
for a payment adjustment in 2018 will receive a 4% PFS reduction regardless if it is their first or fourth year of not demonstrating MU.
in: you will receive a: 2013 1% cut in 2015 2014 2% cut in 2016 2015 3% cut in 2017 2016 3-4% cut in 2018 2017 3-5% cut in 2019 2018 and beyond 3-5% cut
in: you will receive a: 2013 no penalty 2014 1% cut in 2015 & 2% in 2016 If you attested in 2011, 2012 or 2013
and you miss attestation
If you have never attested previously and you miss attestation
Incentive &
Payment
Adjustment
Summary
This table demonstrates
the potential adjustments
over a combination of
Medicare Programs
including the EHR
Incentive Program, PQRS
(Physician Quality
Reporting System) and the
Value Modifier Program.
*Potential loss of 7-9 %
across the 3 programs
The 5 Man Group
This following is a true story based on a 5 provider practice and what can happen if you do not have the right person assisting with your MU Attestations.
$111,680 Incentives that were returned
to CMS from 5 providers
In addition to returning the incentive funds, the providers will
now be subject to 1% in 2015, 2% in 2016 and will increase by a percent every year with a maximum of 5%.
Per a CMS report, the average oncologist had over $325,000 in
Medicare reimbursements in 2012.
For a practice of 5 providers, that would be a loss of $16,250 for
the year. Of course, this amount can vary greatly depending on the number of Medicare patients that are seen by the provider.
Ways to Prevent the Payment
Adjustments
Demonstrate Meaningful Use of Certified Electronic Health Record (EHR)
Technology under the Medicaid Incentive Program
Apply for a Hardship Exception – these Hardship Exceptions are only granted
under very specific circumstances and only if CMS determines that the providers have demonstrated that those circumstances pose a significant barrier to their achieving Meaningful Use
Categories that fall under the Hardship Exceptions in 2014:
Infrastructure
New Eligible Professionals Unforeseen Circumstances Patient Interaction
Things you should
know about audits:
For every year of MU Attestation, you
can be selected for an audit up to 6 years afterwards
There are Pre-payment and
Post-payment audits
Your entire payment is at stake- it’s
All or None. There are no penalties on this money
You can be selected for an audit more
than once
The Eligible Provider is ultimately
responsible for all information submitted for the MU Attestation- your office manager will not have to return the funds; you will
Attest for Meaningful Use with the
assumption you will be audited later!
80% of your patients records MUST be maintained in your EHR to qualify
MU data is collected on ALL of your patients, not just your Medicare patients Designate a point person in your office to oversee all of the documentation
and communication with you as the Eligible Provider
Keep all documentation in a ‘Book of Evidence’ as well as digital copies
A Security Risk Analysis IS REQUIRED to attest to Meaningful Use. This is not
What is a Security Risk Analysis?
A Security Risk Analysis is a
comprehensive look into your
practice to assess how well you are protecting your patients health information (PHI)
It encompasses Technical
Safeguards, Physical Safeguards, and Administrative Safeguards
It must be reviewed every year
(within the Reporting Period for MU)
What to do if you receive notice from
Figliozzi that you are being audited?
Review the documentation to know what you are being asked to supply Enlist your EHR Vendor for support with documentation- EHR Verification
Letter and a copy of your purchase agreement of the software
Only provide what is being requested- nothing more
Don’t miss the deadline given by the auditor; ask for an extension if necessary Keep in mind that the first attempt to reach you will be through the email
address that was used when Registering for the EHR Incentive Program. If this email is not monitored regularly, you may miss the deadline!
What if I fail the Audit?
Appeal Process
If you believe that there is a legitimate
reason to do so, you can file an Appeal
Appeals must be filed within 30 days from
the date of the adverse audit determination letter
Get outside assistance from a reliable
source
Failing an audit does not preclude you
from future, prior, or subsequent year audits
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentiveProgra ms/Downloads/Appeal_EP_FilingRequest-.pdf
Recoupment of Incentives
Even though you may go through the process of filing an Appeal for a failed audit, you will receive a
A few things to keep in mind…
Get qualified help
Don’t expect your Meaningful Use
Attestation, Audit or Appeal to be handled by your Office
Administrator alone
Stay involved in the Process- it’s
your money
Take your documentation with you
if you leave a practice and move to another
