Meaningful Use EHR Incentive Program FAQ
Q: Where do I register to participate in the Medicare and Medicaid EHR Incentive Program?
Q: Under the Medicare and Medicaid EHR Incentive Program, who is responsible for demonstrating meaningful use of certified EHR technology – the provider or the vendor?
A: To receive an EHR incentive payment, the EP (eligible provider) is responsible for demonstrating meaningful use of certified EHR technology under both the Medicare and Medicaid EHR incentive programs. Please contact HITEC-LA for services.
Q: What is the difference between the Medicare and Medicaid Meaningful Use EHR Incentive Programs?
A. There are two EHR Incentive Programs. CMS oversees the Medicare EHR Incentive Program, and the state Medicaid agencies manage the Medicaid EHR Incentive Program. The two programs are similar, but there are some differences between them.
Q: Who is an Eligible Professional under the Medicaid EHR Incentive Program?
A: Eligible professionals under the Medicaid EHR Incentive Program include:
- Physicians (primarily doctors of medicine and doctors of osteopathy)
- Nurse practitioner
- Certified nurse-midwife
- Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.
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.
Q: What report can I generate in Azalea EHR to find out if I meet the 30% / 20% Medicaid patient volume requirement mentioned above?
A: You can generate the Encounter Summary Report in Azalea EHR for any 90-day consecutive period from the prior calendar year for the provider. Then, once you have generated the report you will need to:
- Export the report into an excel spreadsheet
- Sort the excel file from A to Z by the “PRI. INS. NAME” column
- Then divide the number of Medicaid patients listed in the report by the total number of patients in the report to see if the provider meets the minimum 30% / 20% Medicaid patient volume requirement.
Q: What is the maximum incentive an eligible professional (EP) can receive under the Medicaid Electronic Health Record (EHR) Incentive Program?
A: EPs who adopt, implement, upgrade, and meaningfully use EHRs can receive a maximum of $63,750 in incentive payments from Medicaid over a six year period (Note: There are special eligibility and payment rules for pediatricians). EPs must begin receiving incentive payments by calendar year 2016 to receive the maximum payout.
Q: Who is an Eligible Professional under the Medicare EHR Incentive Program?
A: Eligible professionals under the Medicare EHR Incentive Program include:
- Doctor of medicine or osteopathy
- Doctor of dental surgery or dental medicine
- Doctor of podiatry
- Doctor of optometry
Q: What if I’m eligible for both the Medicare EHR Incentive Program and the Medicaid EHR Incentive Program?
A: Eligible professionals eligible for both the Medicare and Medicaid EHR Incentive Programs must choose which incentive program they wish to participate in when they register. Before 2015, an eligible professional may switch programs only once after the first incentive payment is initiated. Most eligible professionals will maximize their incentive payments by participating in the Medicaid EHR Incentive Program.
Q: What is the maximum incentive an eligible professional (EP) can receive under the Medicare Electronic Health Record (EHR) Incentive Program?
A: An EP can receive incentive payments for up to 5 years, with payments beginning as early as 2011. The maximum amount of total payments is $44,000.
The incentive payment is equal to 75% of Medicare fee-for-service allowable charges for covered services furnished (ie, provided) by an EP in a payment year, subject to a maximum payment.
For an early EHR adopter whose first payment year is 2011 or 2012, the maximum payment is $18,000 in the first year. Incentive payments decrease if the first year is after 2012, with annual payment limits in the first, second, third, fourth and fifth years of $15,000, $12,000, $8,000, $4,000 and $2,000, respectively (see table below).
There will be no payments to an EP who first becomes a meaningful EHR user in 2015 or 2016. There will be no payments for meaningful EHR use after 2016.
Incentive payments are increased by 10% for an EP who predominantly furnishes services in a health professional shortage area.
Payment adjustments: For 2015 and 2016, a Medicare EP who does not successfully demonstrate meaningful use will have a 1% payment reduction in Medicare fee-for-service reimbursement. This reduction increases up to 5% for every year that an EP does not demonstrate meaningful use.
Q: How and when will incentive payments for the Medicare Electronic Health Record (EHR) Incentive Programs be made?
A: For eligible professionals (EPs), incentive payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. However, EPs will not receive incentive payments within that timeframe if they have not yet met the threshold for allowed charges for covered professional services furnished by the EP during the year.
Payments will be held until the EP meets the $24,000 threshold in allowed charges for the calendar year in order to maximize the amount of the EHR incentive payment they receive. Medicare EHR incentive payments are based on 75% of the estimated allowed charges for covered professional services furnished by the EP during the entire calendar year. If the EP has not met the $24,000 threshold in allowed charges by the end of calendar year, CMS expects to issue an incentive payment for the EP in March of the following year (allowing two months after the end of the calendar year for all pending claims to be processed).
Payments to Medicare EPs will be made to the taxpayer identification number (TIN) selected at the time of registration, through the same channels their claims payments are made. The form of payment (electronic funds transfer or check) will be the same as claims payments.
Bonus payments for EPs who practice predominantly in a geographic Health Professional Shortage Area (HPSA) will be made as separate lump-sum payments no later than 120 days after the end of the calendar year for which the EP was eligible for the bonus payment.
Please note that the Medicaid incentives will be paid by the states, but the timing will vary according to the state. Please contact your state Medicaid agency for more details about payment.
Q: When I was completing my attestation information on the CMS.gov site, It asked me to enter my * EHR Certification Number. How do I find my EHR Certification Number?
A: To obtain your Azalea EHR Certification Number, follow the instructions outlined here.