"A nurse from one of the largest private schools in our state said that our immunization records are the best looking and cleanest she has ever seen."

— Galen Y.K. Chock, MD, Honolulu, HI

 

Who Is Eligible and What's the Dollar Amounts?

Meaningful Use, and getting the stimulus money, is not as onerous as it sounds - though it certainly requires jumping through a number of hoops and worse still, the HITECH money has been mentioned as being one source of government spending that the GOP would like to cut as described in H.R. 408, the Spending Reduction Act of 2011.

Our overall thoughts on this program and all the hype are discussed here, but most likely the HITECH incentives will be available, and it is our role as your EHR company to ensure you get every dollar available in as painless a process as possible.

Click here for a flow-chart to determine your eligibility.

Who Is Eligible?
All healthcare providers including physicians and nurse practitioners who work in:

  • Any of the 50 US states
  • The District of Columbia
  • Puerto Rico
  • The Virgin Islands
  • Guam
  • American Samoa
  • or Northern Mariana Islands qualify for the HITECH incentive.

Who Is Not Eligible?
The following are not eligible for HITECH incentives (we didn't make the rules, we're just reporting them):

  • Physical therapists
  • Pathologists, anesthesiologists
  • Hospital-based emergency physicians
  • Acupuncturists
  • Holistic medicine providers
  • Free Clinics that don't bill Medicare or Medicaid

Eligible How?
Eligible Providers (EPs) can choose to get money from the Center for Medicare and Medicaid Services (CMS) based on either their Medicare collections or their Medicaid patient volume, but not both.

For those applying for Medicare incentives, which are based on your annual Medicare collections, eligible providers are doctors (MD, DO, DPM, OD, DC) or dentist (DDS, DMD, DDM) who DO NOT perform at least 90 percent of their professional services in a hospital setting, either inpatient or emergency room, in the year preceding the payment year. In other words, providers who perform >90% of their Medicare services in a hospital setting are ineligible (thanks, Paul).

The potential Medicaid incentives are higher, but so are the requirements. The Medicaid incentive is based on the percentage of your patients who are on Medicaid. Eligible Providers for this incentive program must be an MD, DO, CNM, NP, and certain PAs (and dentists) who performs at least 90% of their clinical services in an office-based setting AND whose patient mix include at least 30% Medicaid beneficiaries.

Pediatricians can qualify if their patient mix contains at least 20% Medicaid beneficiaries, and EPs at Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) can qualify if 30% of their patient mix are people in need - defined as patients who have Medicaid, receive uncompensated care, or for whom charges are adjusted on a sliding scale.

Medicare 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.

Medicaid 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.

To receive the Medicaid EHR incentive money, an EP must have a practice composed of a minimum percentage of Medicaid patients as detailed above. The payments for Medicaid are:

$21,250 in year 1
$ 8,500 in year 2
$ 8,500 in year 3
$ 8,000 in year 4
$ 8,500 in year 5
$ 8,500 in year 6
= $63,750 total from Medicaid

Medicaid EHR Incentive Payment Schedule for Eligible Professionals


If Medicaid EP Qualifies to receive first payment in:

2011

2012

2013

2014

2015

2016

Max Payment in 2011

$21,250.00

$0.00

$0.00

$0.00

$0.00

$0.00

Max Payment in 2012

$8,500.00

$21,250.00

$0.00

$0.00

$0.00

$0.00

Max Payment in 2013

$8,500.00

$8,500.00

$21,250.00

$0.00

$0.00

$0.00

Max Payment in 2014

$8,500.00

$8,500.00

$8,500.00

$21,250.00

$0.00

$0.00

Max Payment in 2015

$8,500.00

$8,500.00

$8,500.00

$8,500.00

$21,250.00

$0.00

Max Payment in 2016

$8,500.00

$8,500.00

$8,500.00

$8,500.00

$8,500.00

$21,250.00

Max Payment in 2017

$0.00

$8,500.00

$8,500.00

$8,500.00

$8,500.00

$8,500.00

Max Payment in 2018

$0.00

$0.00

$8,500.00

$8,500.00

$8,500.00

$8,500.00

Max Payment in 2019

$0.00

$0.00

$0.00

$8,500.00

$8,500.00

$8,500.00

Max Payment in 2020

$0.00

$0.00

$0.00

$0.00

$8,500.00

$8,500.00

Max Payment in 2021

$0.00

$0.00

$0.00

$0.00

$0.00

$8,500.00

TOTAL Max Incentive Payments

$63,750.00

$63,750.00

$63,750.00

$63,750.00

$63,750.00

$63,750.00

So What is Meaningful Use?
Unfortunately, it isn't as easy as just owning or using an EHR. First, the EHR must be certified by an ONC-ATCB (Office of the National Coordinator Authorized Testsing & Certification Body) as being Meaningful Use Certified. Only EHRs that are ONC-ATCB certified can get you the money. One important detail is that many EHRs are not certified as a complete solution and thus require other certified software to be eligible to receive these monies. Examples include Practice Fusion and Ingenix Care Tracker. (Amazing Charts is 100% certified as a complete solution, so it is the only EHR you need.) Information on which EHRs are certified and whether they are compete or just modular are listed on the ONC website.

To get the HITECH money, the provider must show they are using an ONC-ATCB certified EHR "meaningfully." So the government has spent tons of time and money defining what this means, and have come up with 25 meaningful use objectives. To qualify for money, 20 of the 25 must be met using an ONC-ATCB certified EHR. Here are some examples of these requirements:

  • More than 30% of unique patients with at least one medication seen by the eligible provider (EP) must have been prescribed electronically, and more than 40% of all permissible prescriptions must be transmitted electronically using certified EHR technology.
  • The ability to implement electronic drug-drug and drug-allergy interaction checking must be enabled for the entire reporting period.
  • More than 50% of the unique patients seen by the EP must have a preferred language, gender, race, ethnicity, and DOB documented as structured data.
  • And a whole bunch more discussed here.

There are also Clinical Quality Measures that must be met such as BP measurements, assessment of tobacco use, etc. All of the objectives and how they are measured and reported are detailed here, and full details on all these CMS incentive programs can be found at the CMS EHR Incentive Program website.

Amazing Charts is ONC-ATCB certified as complete EHR (see our details here and compare our abilities to any other EHRs you are considering). More importantly, we have a Meaningful Use Wizard™ and built in dashboard that provides real-time information to ensure you are documenting the required information and that makes the process of generating the required reports a relatively easy task.

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