What you need to know:

The fundamental information you need to know about the CMS EHR Medicare and Medicaid ARRA incentive programs*. This information is provided by Qubitz Medical as a service to all healthcare providers wishing to learn more about the CMS EHR Medicare and Medicaid incentive programs. Information provided here is derived from the official CMS website. * Please visit the official CMS website for complete information about these programs. No solicitation for services or provision of legal advice is expressed or implied by providing this information.

• What is EHR?
• What is the Medicare EHR Incentive Program?
• What is the Medicaid EHR Incentive Program?
• Who is eligible to participate in these programs?
• Can I participate in both programs if I am eligible for both?
• What are the incentive amounts for each program?
• When do these programs begin?
• How long will the programs be in place?
• What is the registration process ? CLICK HERE for the CMS Registration Video
• What is "Meaningful Use" ?
• What is "Certified EHR Technology"?

What are the Medicare and Medicaid EHR Incentive Programs?

The Medicare EHR Incentive Program 

• The Medicare EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology.
• Participation can begin as early as 2011.
• Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program. There's an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HSPA).
• To get the maximum incentive payment, Medicare eligible professionals must begin participation by 2012.Incentive payments for eligible hospitals and CAHs may begin as early as 2011 and are based on a number of factors, beginning with a $2 million base payment.
• Important! For 2015 and later, Medicare eligible professionals, eligible hospitals, and CAHs that do not successfully demonstrate meaningful use will have a payment adjustment in their Medicare reimbursement.

The Medicaid EHR Incentive Program

• The Medicaid EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their first year of participation and demonstrate meaningful use for up to five remaining participation years.
• The Medicaid EHR Incentive Program is voluntarily offered by individual states and territories and may begin as early as 2011, depending on the state.
• Eligible professionals can receive up to $63,750 over the six years that they choose to participate in the program.
• Eligible hospital incentive payments may begin as early as 2011, depending on when the state begins its program. The last year a Medicaid eligible hospital may begin the program is 2016. Hospital payments are based on a number of factors, beginning with a $2 million base payment.
• There are no payment adjustments under the Medicaid EHR Incentive Program.

Who is eligible to participate in these programs?

Eligibility Requirements for Professionals

• Incentive payments for eligible professionals are based on individual practitioners.
• If you are part of a 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 provide services.
• Hospital-based eligible professionals are not eligible for incentive payments. An eligible professional 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.

Who is an Eligible Professional under the Medicare EHR Incentive Program?

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
• Chiropractor

Who is an Eligible Professional under the Medicaid EHR Incentive Program?

Eligible professionals under the Medicaid EHR Incentive Program include:

• Physicians (primarily doctors of medicine and doctors of osteopathy)
• Nurse practitioner
• Certified nurse-midwife
• Dentist
• 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.

Can I participate in both programs if I am eligible for both?

Eligible for Both Programs?

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.

What are the incentive amounts for each program?

If you're an eligible professional, become a meaningful user of certified electronic health records to qualify for incentive payments of up to $44,000 from Medicare.

If you're an eligible professional, in your first year of participation you may adopt, implement or upgrade or become a meaningful user of certified electronic health records to qualify for incentive payments of up to $63,750 from Medicaid.

When do these programs begin?

• October 1, 2010 – Reporting year begins for eligible hospitals and CAHs.
• January 1, 2011 – Reporting year begins for eligible professionals.
• January 3, 2011 – Registration for the Medicare EHR Incentive Program begins.
• January 3, 2011 – For Medicaid providers, states may launch their programs if they so choose.
• April 2011 – Attestation for the Medicare EHR Incentive Program begins.
• May 2011 – EHR Incentive Payments expected to begin.
• July 3, 2011 – Last day for eligible hospitals to begin their 90-day reporting period to demonstrate meaningful use for the Medicare EHR Incentive Program.
• September 30, 2011 – Last day of the federal fiscal year. Reporting year ends for eligible hospitals and CAHs.
• October 1, 2011 – Last day for eligible professionals to begin their 90-day reporting period for calendar year 2011 for the Medicare EHR Incentive Program.
• November 30, 2011 – Last day for eligible hospitals and critical access hospitals to register and attest to receive an Incentive Payment for Federal fiscal year (FY) 2011.
• December 31, 2011 – Reporting year ends for eligible professionals.
• February 29, 2012 – Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year (CY) 2011.

How long will the programs be in place?

Medicare EHR Incentive Program
The Medicare EHR Incentive Program for eligible professionals starts in 2011 and will continue through 2016. Depending on the first year they participate, eligible professionals can participate for up to 5 years throughout the duration of the program. The last year to begin participation in the Medicare EHR Incentive Program is 2014.

• To qualify for Medicare EHR incentive payments, Medicare eligible professionals must successfully demonstrate meaningful use for each year of participation in the program.
• Incentive payments are made based on the calendar year. The reporting period for the first year is any 90 continuous days during the calendar year. The reporting period for all subsequent years is the entire calendar year.
• For calendar years 2011–2016, eligible professionals who demonstrate meaningful use of certified EHR technology can receive up to $44,000 over 5 years under the Medicare EHR Incentive Program. See the payment table below for more information.
• To receive the maximum EHR incentive payment, Medicare eligible professionals must begin participation by 2012.
• Important! For 2015 and later, Medicare eligible professionals who do not successfully demonstrate meaningful use will have a payment adjustment to their Medicare reimbursement. The payment reduction starts at 1% and increases each year that a Medicare eligible professional does not demonstrate meaningful use, to a maximum of 5%.
• Medicare eligible professionals who also qualify as a Medicaid eligible professional must choose between the Medicare and Medicaid incentive programs when they register. Not sure which program to register for? Find more information in the EHR Incentive Programs Overview page.

Medicaid eligible professionals and providers who are not eligible to participate in the Medicare and Medicaid EHR Incentive Programs will not be subject to payment adjustments. However, Medicaid eligible professionals who also treat Medicare patients will have a payment adjustment to Medicare reimbursements starting in 2015 if they do not successfully demonstrate meaningful use.

Additional incentives are available! Medicare eligible professionals who predominantly furnish services in an area designated as a Health Professional Shortage Area (HPSA) will receive a 10% increase in their annual EHR incentive payments.

NOTE: The additional 10% HPSA incentive is not available for eligible professionals who participate in the Medicaid EHR Incentive Program.

Medicaid EHR Incentive Program

The Medicaid EHR Incentive Program is offered and administered voluntarily by states and territories. States can start offering their program to eligible professionals as early as 2011. The program continues through 2021. Eligible professionals can participate for 6 years throughout the duration of the program. The last year to begin participation in the Medicaid EHR Incentive Program is 2016.

• To qualify for Medicaid incentive payments, Medicaid eligible professionals must adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in the first year of participation, and successfully demonstrate meaningful use in subsequent participation years.
• For calendar years 2011–2021, participants can receive up to $63,750 over 6 years under the Medicaid EHR incentive program. EHR incentive payments are made by the state based on the calendar year. See payment table below.
• Medicaid eligible professionals who also qualify as Medicare eligible professionals must choose between the Medicare and Medicaid EHR Incentive Programs when they register. Not sure which program to register for? Find more information in the Overview page.
• Medicaid eligible professionals and providers who are not eligible to participate in the Medicare and Medicaid EHR Incentive Programs will not be subject to payment adjustments. However, Medicaid eligible professionals who also treat Medicare patients will have a payment adjustment to Medicare reimbursements starting in 2015 if they do not successfully demonstrate meaningful use.

Medicaid EHR Incentive Payment Schedule for Eligible Professionals

What is "Meaningful Use"?

The American Recovery and Reinvestment Act of 2009 specifies three main components of Meaningful Use:

1. The use of a certified EHR in a meaningful manner, such as e-prescribing.
2. The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
3. The use of certified EHR technology to submit clinical quality and other measures.

Simply put, "meaningful use" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.

What are the requirements for Stage 1 of Meaningful Use (2011 and 2012)?
Meaningful use includes both a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals and CAHs.

• For eligible professionals, there are a total of 25 meaningful use objectives.  To qualify for an incentive payment, 20 of these 25 objectives must be met.
• • There are 15 required core objectives.
  • The remaining 5 objectives may be chosen from the list of 10 menu set objectives.
• For eligible hospitals and CAHs, there are a total of 24 meaningful use objectives. To qualify for an incentive payment, 19 of these 24 objectives must be met.
• • There are 14 required core objectives.
  • The remaining 5 objectives may be chosen from the list of 10 menu set objectives.

   

What are "Clinical Quality Measures"?

To demonstrate meaningful use successfully, eligible professionals, eligible hospitals and CAHs are required also to report clinical quality measures specific to eligible professionals or eligible hospitals and CAHs.

• Eligible professionals must report on 6 total clinical quality measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures (selected from a set of 38 clinical quality measures).
• Eligible hospitals and CAHs must report on all 15 of their clinical quality measures.

What is "Certified EHR Technology"?

Certification for the Medicare and Medicaid EHR Incentive Programs

The Medicare and Medicaid EHR Incentive Programs require the use of certified EHR technology. Standards, implementation specifications, and certification criteria for EHR technology have been adopted by the Secretary of the Department of Health and Human Services. EHR technology must be tested and certified by an Office of the National Coordinator (ONC) Authorized Testing and Certification Body (ATCB) in order for a provider to qualify for EHR incentive payments. Click List of Certified EHR Technology (CHPL)

IMPORTANT: Even if you are already using EHR technology, it must be tested and certified by an ONC-ATCB specifically for the Medicare and Medicaid EHR Incentive Programs.

Where to find Certified EHR Technology for the Medicare and Medicaid EHR Incentive Programs

EHR technologies that meet the certification requirements for the Medicare and Medicaid EHR Incentive Programs are listed on the ONC Web site. Click "List of Certified EHR Technology (CHPL)" in the "Related Links Outside CMS" section below.

REMEMBER: You do not need to have your certified EHR technology in place to register for the EHR incentive programs! However, you must adopt, implement, upgrade, or successfully demonstrate meaningful use of certified EHR technology under the Medicaid EHR Incentive Program and successfully demonstrate meaningful use of certified EHR technology under the Medicare EHR Incentive Program before you can receive an EHR incentive payment.

What is EHR?

Electronic Health Record (EHR) or Electronic Medical Record (EMR)?

Sometimes people use the terms "Electronic Medical Record" or "EMR" when talking about Electronic Health Record (EHR) technology. Very often an Electronic Medical Record or EMR is just another way to describe an Electronic Health Record or EHR, and both providers and vendors sometimes use the terms interchangeably. For the purposes of the Medicare and Medicaid Incentive Programs, eligible professionals, eligible hospitals and critical access hospitals (CAHs) must use ­certified EHR technology. Certified EHR technology gives assurance to purchasers and other users that an EHR system or module offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria. Certification also helps providers and patients be confident that the electronic health IT products and systems they use are secure, can maintain data confidentially, and can work with other systems to share information. For more information about which EHR systems and modules are certified for the Medicare and Medicaid EHR Incentive Programs, please visit http://healthit.hhs.gov/.