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Medicare Incentives Payments Tip Sheet



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Meaningful Use Incentives Requirements


The HITECH Act specifies a plan that can provide eligible providers up to $44,000 in Medicare or $63,750 in Medicaid incentives. How do you quality and what does this all mean?

What does it mean to be an eligible provider (EP)?

  • For hospitals to be eligible, they can be acute care (excluding long term care facilities), critical access hospitals or children’s hospitals. These hospitals that I have just mentioned are the ONLY facilities covered or addressed in the Meaningful Use Rules.
  • When it comes to defining an eligible provider for EHR incentive payment purposes, there is a difference between the requirements for Medicare and Medicaid.
  • Medicare defines an eligible provider according to the definition in the Social Security Act section 1861(r):
    • Doctor of Medicine
    • Doctor of Osteopathy
    • Doctor of dental surgery
    • Dental Medicine
    • Doctor of Podiatric Medicine
    • Doctor of Optometry
    • Chiropractor
  • Medicaid defines an eligible provider as follows (ARRA p.377):
    • Physician
    • Dentist
    • Certified Nurse-Midwife
    • Nurse Practitioner
    • Physician Assistant (who is practicing in a Federally Qualified Health Center (FQHCs) or Rural Health Clinic (RHCs) led by a Physician Assistant)

How does this affect psychologists, social workers, and other therapists and mental health professionals? (Are YOU eligible for stimulus package EHR incentives?)

  • Under current stimulus package guidelines, the following mental health professionals are eligible for stimulus money: Medicare: Psychiatrists (MD) (physician). Medicaid: Psychiatrists (MD) (Physician) and Nurse Practitioners (NP, ARNP). At this point of time, these guidelines are law.

Does the Meaningful Use Incentive Guidelines recognize Behavior Health, Mental Health or substance abuse treatment facilities as providers that can receive Medicare or Medicaid Meaningful Use Incentives?

  • No, it does not. However, 3 bills have been introduced in April thru August in both the House and the Senate that would allow behavioral, mental health, and substance abuse treatment providers to qualify for incentives.
  • The new Health Information Technology Extension for Behavioral Health Services Act of 2010. They are HR 5025, HR 5040, S 3709.
  • The passage of one of these would extend eligibility for stimulus incentive payments to: Behavioral and mental health professionals and clinics, Substance abuse professionals and treatment facilities, Psychiatric hospitals, and Licensed psychologists and clinical social workers.
  • Sadly, there is very little movement now and none expected until after the New Years Break.

Just what is the definition of Meaningful Use and what does it mean to you and your way of practice?

  • Meaningful use is described as using an electronic means to capture, record, transmit and use a patient’s health information in a Meaningful Way.
  • The Meaningful Use Workgroup established the following definition they used to guide them through the rule building process. “We recommend that the ultimate goal of meaningful use of an electronic health record is to enable significant and measurable improvements in population health through a transformed health care delivery system.”
  • In order to lay out a path to this ultimate goal of “a transformed health care delivery system” the Department of Health and Human Services has established the Final Rule 42 CRF Parts 412, 413, 422, et al, that breaks the Meaningful Use overall goal into three Stages.
    • Stage 1 meaningful use is capturing and sharing the data, securely
    • Meaningful use in Stage 2 is advanced clinical processes
    • Stage 3 is starting to look at meaningful use of an EHR in the context of improved healthcare outcomes.

What are the Stage 1 Requirements?

  • Use of an EHR system that has been certified by an Authorized Testing and Certification Body (ATCB) which has been approved by the Office of the National Coordinator (ONC). This certification is generally known as ONC-ATCB Certification.
  • Use of a certified EHR in a meaningful manner such as e-prescribing.
  • Use of a certified EHR Technology for the exchange of health information (exchange data with other providers of care of business partners such as labs or pharmacies).

How much money does this mean to me?

  • If I am an eligible provider and if I have or purchased a Certified EHR system AND if I use the Certified EHR system in a meaningful way the incentive program will work like this:
    • Eligible providers who show meaningful use of a certified EHR can receive up to $44,000 from Medicare OR $63,750 from Medicaid.
    • Office-based physicians practicing in rural or underserved areas are eligible for an additional 10% (up to $48,000) in Medicare incentives.
    • These figures represent the maximum allowable incentives under the Medicare and Medicaid programs based on a percentage of actual annual revenue received from Medicare and Medicaid.
    • Providers must choose between applying for the Medicare or Medicaid funding- they may not receive incentives from both.

When do I have to start meaningfully using the Certified EHR in order to receive the money?

  • Eligible providers who show meaningful use of a certified EHR for at least a 90 day period during 2011 can start receiving money for that year.
  • In order to receive the full incentive amount an Eligible provider must start participating in Meaningful Use in 2011.
  • Healthcare providers must verify that they have demonstrated meaningful use of certified electronic health records for any 90 day period during 2011.

What do you, as an Eligible Provider, have to do to show Meaningful Use of the Certified EHR that you either have or just purchased?

  • The Meaningful Use criteria have been divided into two groups
  • The mandatory core set, containing 16 requirements, 10 of which have % thresholds the EPs must be meet.
  • The menu set, from which hospitals and EPs may choose five of the 10 criteria.
    • An example of one of the meaningful use core set requirements would be e-prescribing.
  • The entry from the “Final Rule” states that In order to demonstrate Meaningful Use of the e-prescribing core requirement the Eligible Provider must be:
    • Using Certified EHR technology, to write and transmit electronically, at least 40% of all permissible prescriptions.

What will be coming in the next few years for DocuTrac and the Meaningful Use Incentive?

  • In the Behavioral Health, Mental Health and Substance Abuse software industry, QuicDoc has been the “Gold Standard” for clinical documentation for years and we plan on continuing that standard of use as well as expanding our product to help “transform the healthcare delivery system” and meet the vision that the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) have for this new Electronic Health Record System.
  • Partner with us at DocuTrac to help you stay abreast of the changes to the rules and ahead of the documentation requirements that are sure to follow.