Q: For the Medicaid EHR Incentive Program, can a provider include encounters in his or her Medicaid patient volume calculation numerator if Medicaid did not pay for the service? For example, this might include individuals dually eligible for Medicare and Medicaid, when there is third-party liability, or when Medicaid did not pay for an encounter (even if the patient was Medicaid eligible).
A: The definitions of "encounter" for both needy individual and Medicaid patient volume account for situations where "Medicaid. paid all or part of the individual's premiums, copayments, and cost-sharing." This will include individuals, such as Qualified Medicare Beneficiaries (QMBs), where Medicare may pay for the encounter, but the State Medicaid program is required to pay for the individuals' Medicare Part B premiums. It would also include when Medicaid (or Children's Health Insurance Program (CHIP), as it pertains to needy individual patient volume) paid for the premiums, cost-sharing, or co-payments for privately provided insurance (including Medicaid managed care programs).
If a third-party pays for the encounter (e.g., Worker's Compensation, auto insurance, etc.), the individual is only included in numerator for patient volume when "Medicaid. paid all or part of the individual's premiums, copayments, and costsharing." Again, this will include enrollees of Medicaid (or CHIP, as it pertains to needy individual patient volume) when Medicaid paid for the premiums, costsharing, or co-payments for privately provided insurance (including Medicaid managed care programs).
Finally, if a fee-for-service Medicaid enrollee has an encounter and Medicaid does not pay for the encounter (e.g., the individual paid out of pocket or because the service is not a Medicaid-covered service), they cannot be included in the numerator for calculating Medicaid patient volume.
[Source: CMS Electronic Health Record (EHR) Incentive Programs FAQs]
Q: Do physicians and other eligible professionals register only once for the Medicare and Medicaid EHR Incentive Programs, or must they register every year?
A: Providers are only required to register once for the Medicare and Medicaid EHR Incentive Programs. However, they must successfully demonstrate that they have either adopted, implemented, or upgraded (first participation year for Medicaid) or meaningfully used certified EHR technology each year in order to receive an incentive payment for that year. Additionally, providers seeking the Medicaid incentive must annually re-attest to other program requirements, such as meeting the required patient volume thresholds. Providers will register using the Medicare and Medicaid EHR Incentive Program Registration & Attestation System, a web-based system. Providers who have elected to participate in the Medicare EHR Incentive Program will also use this system to attest to their program eligibility and meaningful use. Providers who select the Medicaid EHR Incentive Program will demonstrate their eligibility and attest via their State Medicaid Agency's system. If any basic registration information changes, the provider will need to update his or her information in the Medicare and Medicaid EHR Incentive Program Registration & Attestation System.
Q: It is my understanding that eligible professionals (EPs) cannot earn both the Medicare EHR incentive and the Medicare electronic prescribing (eRx) incentive during the same program year. Should I still submit the eRx measure in order to avoid the negative payment adjustment in 2012 even if I intend to register for and attest under the Medicare EHR Incentive program?
A: You are correct. EPs who earn an incentive under the Medicare EHR Incentive Program, cannot receive an incentive payment under the eRx Incentive Program in the same program year, and vice versa. However, EPs participating through the Medicaid option may still receive an incentive payment under the eRx Incentive Program in the same program year. CMS has indicated that EPs should report the eRx measure in 2011 under the Medicare eRx Incentive Program even if their practice is also participating in the Medicare EHR Incentive Program because claims data for the first six months of 2011 will be analyzed to determine if a 2012 eRx Payment Adjustment will apply to the EP. Additionally, if an EP successfully generates and reports electronically prescribing 25 times (at least 10 of which are in the first 6 months of 2011 and submitted via claims to CMS) for eRx measure denominator eligible services, he or she would also be exempt from the 2013 eRx payment adjustment.
Q. What is meaningful use, and how does it apply to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs?
A. Under the Health Information Technology for Economic and Clinical Health (HITECH Act), which was enacted under the American Recovery and Reinvestment Act of 2009 (Recovery Act), incentive payments are available to eligible professionals (EPs), critical access hospitals, and eligible hospitals that successfully demonstrate are meaningful use of certified EHR technology.
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 information to improve quality of health care
- The use of certified EHR technology to submit clinical quality and other measures
In the Medicare and Medicaid EHR Incentive Program (final rule), CMS has defined stage one of meaningful use.
To view the final rule, please visit: http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf.
For more information about the Medicare and Medicaid EHR Incentive Program, please visit http://www.cms.gov/EHRIncentivePrograms.
For more information, educational opportunities, and resources from MSMS, visit www.msms.org/hit.
Q: Which clinicians qualify as eligible professionals (EPs) under the Medicare and Medicaid Electronic Health Record (EHR) technology incentive programs? And, is it true that hospital-based EPs are not eligible?
A: Under the Medicare incentive, an eligible professional is a Doctor of Medicine or Osteopathy, Doctor of Dental Surgery or Dental Medicine, Doctor of Optometry, Chiropractor, or Podiatrist. Under the Medicaid incentive, an eligible professional is a Physician, Dentist, Certified Nurse Midwife, Nurse Practitioner, Physician Assistant (when practicing at a FQHC or Rural Health Center led by a Physician Assistant). Hospital-based EPs do not qualify for either the Medicare or Medicaid EHR incentive payments. The final rule defines a hospital-based EP as an EP who furnishes 90 percent or more of his or her services in a hospital inpatient setting or hospital emergency room.
Q: Can one participate in both Medicare and Medicaid electronic health records (EHR) incentive programs?
A: No. You will need to pick one. If you qualify for both the Medicare and Medicaid EHR incentive programs, there is a one-time switch policy. Once you receive an incentive payment under one of the programs, you can switch to the other program, but the one-time switch must occur by 2015.
Q: What is the difference between an EMR and an EHR?
A: An electronic medical record (EMR) is an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization. An electronic health record (EHR) is an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, gathered, managed, and consulted by authorized clinicians and staff across more than one health care entity. (Source: "Defining Key Health Information Technology Terms", Report to the Office of the National Coordinator for HIT, April 28, 2008)
Q: What is "certified" electronic health record (EHR) technology?
A: The Medicare and Medicaid EHR Incentive Programs require the use of certified EHR technology, as established by a new set of standards and certification criteria. Existing EHR technology needs to be certified by an ONC-Authorized Testing and Certification Body (ONC-ATCB) to meet these new criteria in order to qualify for the incentive payments.
Through the temporary certification program, new certification bodies have been established to test and certify EHR technology. Vendors can submit their EHR products to the certifying bodies to be tested and certified. Hospitals and practices who have developed their own EHR systems or products can also seek to have their existing systems or products tested and certified. Complete EHRs may be certified as well as EHR modules that meet at least one of the certification criteria. Once a product is certified, the name of the product will be published on the Office of the National Coordinator for Health Information Technology (ONC) Website - http://healthit.hhs.gov/CHPL.
Practices that are in discussions with a vendor should confirm the certification status of their products. Practices should negotiate protections and/or vendor consequences should the product not be certified.
Q: If my electronic health record (EHR) system is CCHIT certified, does that mean it is certified for the Medicare and Medicaid EHR Incentive Programs?
A: Maybe. CCHIT is one of the ONC-ATCBs; however, they also certified products prior to the development of the new standards and certification criteria. Because all EHR systems and technology must be certified specifically for the federal EHR incentive program, you need to make sure that your EHR technology (including the version you’re using) is listed on the Certified Health IT Product List. This is a list of all complete EHRs and EHR modules that have been certified for the purposes of this program and is available at http://healthit.hhs.gov/CHPL.
Q: What is the reporting period for eligible professionals (EPs) participating in the electronic health record (EHR) incentive programs?
A: For demonstrating meaningful use through both the Medicare and Medicaid EHR Incentive Programs, the EHR reporting period for an EP's first year is any continuous 90-day period within the calendar year. In subsequent years, the EHR reporting period for EPs is the entire calendar year.
Q: Can an eligible professional (EP) implement an electronic health record (EHR) system and satisfy meaningful use requirements at any time within the calendar year for the Medicare and Medicaid EHR Incentive Program?
A: For a Medicare EP's first payment year, the EHR reporting period is a continuous 90-day period within a calendar year, so an EP must satisfy the meaningful use requirements for 90 consecutive days within their first year of participating in the program to qualify for an EHR incentive payment. In subsequent years, the EHR reporting period for EPs will be the entire calendar year. With regard to the Medicaid EHR Incentive program, EPs must have adopted, implemented, upgraded, or meaningfully used certified EHR technology during the first calendar year. If the Medicaid EP adopts, implements or upgrades in the first year of payment, and demonstrates meaningful use in the second year of payment, then the EHR reporting period in the second year is a continuous 90-day period within the calendar year; subsequent to that, the EHR reporting period is then the entire calendar year.
Q: How and when will incentive payments for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program be made?
A: Incentive payments for the Medicare EHR Incentive Program will be made approximately four to six weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. Payments to Medicare providers 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. While CMS expects that Medicare incentive payments will begin in May 2011, payments will be held for EPs until the EP meets the $24,000 threshold in allowed charges. Medicaid incentives will be paid by the States and are also expected to begin in 2011, but the timing will vary by state.
Q: Is an Eligible Provider (EP) who sees Medicare patients but is officially a Medicare "non-participant" still able to receive incentive payments through the Medicare EHR Incentive Program?
A: Yes. If the EP submits claims to Medicare for treating Medicare patients, meets the other eligibility requirements, and successfully demonstrates the meaningful use of certified EHR technology, he or she can qualify for incentives. An EP does not have to be "participating" with Medicare to earn incentives.
Q: What if my electronic health record (EHR) system costs much more than the incentive the government will pay? May I request additional funds?
A: The Medicare and Medicaid EHR Incentive Programs provide incentives for the meaningful use of certified EHR technology. Under the Medicaid program, there is also an incentive for the adoption, implementation, or upgrade of certified EHR technology in the first year of participation. The incentives are not a reimbursement of costs, and maximum payments have been set.
Q: How should eligible professionals (EPs) select menu objectives for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs?
A: EPs are required to report on 5 Menu Set objectives. CMS is encouraging EPs to choose Menu Set objectives that are relevant to their scope of practice, and claim an exclusion only when there are no remaining objectives for which they qualify or if there are no remaining objectives that are relevant to their scope of practice. Thus, CMS hopes that you will report on 5 measures that are relevant to your scope of practice and that you can report on, even if you qualify for exclusions in other objectives. Please note that you must choose one public health menu set objective; however, if you can be excluded from both public health menu objectives, you should claim an exclusion from only one public health objective and report on four additional menu objectives from outside the public health menu set.
Q: What is the earliest date the payment adjustments will start to be imposed on Medicare eligible professionals (EPs) and eligible hospitals that do not demonstrate meaningful use of certified electronic health record (EHR) technology?
A: Medicare payment adjustments will begin in 2015 for EPs and eligible hospitals that do not demonstrate meaningful use of certified EHR technology. There are no payment adjustments associated with the Medicaid provisions under Section 4201 of the American Recovery and Reinvestment Act of 2009.
For more information, educational opportunities, and resources from MSMS, visit www.msms.org/hit.