CMS Final Rule Incentive Programs for Eligible Professionals 1 On demand webinars are best heard through a headset or earphones (ipod for example) that can be plugged into your laptop or desktop. Download the handouts that accompany this presentation. Other related links and documents found in Final Rules section in the subscribers library. 2 Bill Oravecz is Managing Partner of WTO ssociates LLC. His engagement teams help various healthcare and life science organizations by enhancing their effectiveness and productivity through their 5-Point nalysis pproach. WTO s Healthcare IT Practice helps clients with the doption of EHR Systems, Meaningful Use, Privacy & Security of patient records and compliance issues. Bill has 26 years of healthcare technology and IT solutions delivery experience through various senior management positions with major IT services and healthcare technology firms. He holds a MB from University of Connecticut and a SM in Radiology from The Pritzker School of Medicine at the University of Chicago. You can reach him at: woravecz@wto-associates.com 3
The HITECH ct provides for incentive payments to EPs and EHs who are meaningful users of certified EHR technology during a relevant EHR reporting periods.the Department of Health and Human Services (HHS) agency Centers for Medicare & Medicaid Services (CMS) issued the final rule on Medicare and Medicaid Programs; Electronic Health Record. The regulations were effective on September 27, 2010. The initial criteria EPs, eligible hospitals, and CHs must meet in order to qualify for an incentive payment Calculation of the incentive payment amounts Payment adjustments under Medicare for covered professional services and inpatient hospital services provided by EPs, eligible hospitals and CHs failing to demonstrate meaningful use of certified EHR technology Other program participation requirements e-prescribing Incentive Program created by Medicare Improvements for Patients and Providers ct (MIPP) Medicare FFS or M EP is not eligible for both Medicare EHR and e-prescribing incentives. e-prescribing Incentive Program created by Medicare Improvements for Patients and Providers ct (MIPP) Medicaid EP can receive both Medicaid EHR and e-prescribing incentives. Medicare Physician Quality Reporting Initiative (PQRI) EPs are eligible for both. Medicare Electronic Health Record Demonstration (EHR Demo) - EPs are eligible for both. Once an EP has selected an EHR program, they are permitted to make a one-time switch from one program to the other
Three Programs Medicaid Medicare Fee-for-Service (FFS) Medicare dvantage (M) Organization Question 1 Did you perform 90% of your services in an inpatient hospital or emergency room hospital setting? You are T currently eligible to receive EHR incentive payments Go to Question 2 Question 2 Were at least 30% of your services furnished to Medicaid patients in an outpatient setting (20% requirement for pediatricians)? re you one of the following? * Physician * Dentist * Certified nurse midwife * Nurse Practitioner * P practicing in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) led by a Physician ssistant Go to Question 3 You are T currently eligible to receive EHR incentive payments If you adopt, implement, upgrade, or successfully demonstrate MU of certified EHR technology, you may be eligible for the MEDICID incentive program.
Question 3 Did you practice predominantly in a Federally Qualified Health Center or Rural Health Clinic with a 30% needy individual* patient volume threshold? re you one of the following? * Physician * Dentist * Certified nurse midwife * Nurse Practitioner * P practicing in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) led by a Physician ssistant Go to Question 4 You are T currently eligible to receive EHR incentive payments If you adopt, implement, upgrade, or successfully demonstrate MU of certified EHR technology, you may be eligible for the MEDICID incentive program. Question 4 Do you treat Medicare Patients? re you one of the following? * Doctor of medicine or osteopathy * Doctor of oral surgery * Doctor of dental medicine * Doctor of podiatric medicine * Doctor of optometry * Chiropractor You are T currently eligible to receive EHR incentive payments If you successfully demonstrate meaningful use, you may be eligible for the MEDICRE incentive program Medicare vs. Medicaid Medicare Federal Government will implement (will be an option nationally) Payment reductions begin in 2015 for providers that do not demonstrate meaningful use Must demonstrate MU in year 1 and every subsequent year to qualify for the incentives Maximum incentive is $44,000 for EPs (bonus for EPs in HPSs) MU definition is common for Medicare Last year a provider may initiate program is 2014; Last year to register is 2016; Payment adjustments begin in 2015. Only physicians, subsection (d) hospitals and CHs are eligible. Medicaid Voluntary for States to implement (may not be an option in every state) No Medicaid payment reductions Can qualify for incentive payments after adopting, implementing or demonstrating MU in the first participating year. Required to demonstrate MU in each subsequent year to qualify for incentive Maximum incentive is $63,750 for EPs States can adopt certain additional requirements for MU Last year a provider may initiate program is 2016; Last year to register is 2016. 5 type of EPs, acute care hospitals including CHs and children's hospital are eligible.
Calendar Year Qualifying EPs Five types of Medicaid professionals Physicians Dentists Certified nurse-midwives Nurse practitioners Physician assistants practicing in a FQHC or RHC EP can not be hospital based Qualifying EPs must meet patient thresholds 30 percent patient volume receiving Medicaid pediatrician must have 20 percent patient volume receiving Medicaid EPs practicing predominantly in an FQHC or RHC must have a minimum of 30 percent patient volume attributable to needy individuals. Practicing in a FQHC or RHC Medicaid Payment Schedule Maximum Incentive Payments for Medicaid EPs Who re Meaningful Users in the First Payment Year 2011 $21,250 Medicaid EPs who begin adoption in 2011 2012 2013 2014 2015 2016 2012 $8,500 $21,250 2013 $8,500 $8,500 $21,250 2014 $8,500 $8,500 $8,500 $21,250 2015 $8,500 $8,500 $8,500 $8,500 $21,250 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 2017 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $8,500 $8,500 $8,500 $8,500 2019 $8,500 $8,500 $8,500 2020 $8,500 $8,500 2021 $8,500 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 15
Qualifying EPs Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatric medicine Doctor of optometry Chiropractor Incentive payment amount for EPs is subject to an annual limit equal to 75 percent of Medicare allowed charges for covered professional services furnished during the payment year. The calculation of allowed charges will be based on claims submitted to Medicare no later than two months following the end of the payment year. The EP is entitled to an incentive payment for up to five years. There will be no incentive payments made after 2016. Medicare Payment Schedule Maximum Total mount of EHR Incentive Payments for a Medicare EP not Predominantly in a Health Professional Shortage rea (HPS) First CY EP Receives and Incentive Payment 2011 2012 2013 2014 2015 - subsequent years C L E N D R Y E R 2011 $18,000 2012 $12,000 $18,000 2013 $8,000 $12,000 $15,000 2014 $4,000 $8,000 $12,000 $12,000 $0 2015 $2,000 $4,000 $8,000 $8,000 $0 2016 $2,000 $4,000 $4,000 $0 Total $44,000 $44,000 $39,000 $24,000 $0
n HPS will receive a 10% increase in incentive payments. CMS considers predominately if more than 50 percent of the eligible professional s Medicare covered professional services are furnished in a geographic HPS. The 50 percent will be based on frequency of services provided versus a percentage of allowed charges. 19 HPS Payment Schedule Maximum Total mount of Incentive Payments for a Medicare EP Who Predominantly Performs Services in a HPS C L E N D R Y E R 2011 $19,800 Yr that EP Becomes EHR User in a HPS 2011 2012 2013 2014 2012 $13,200 $19,800 2013 $8,800 $13,200 $16,500 2015 - subsequent years 2014 $4,400 $8,800 $13,200 $13,200 $0 2015 $2,200 $4,400 $8,800 $8,800 $0 2016 $2,200 $4,400 $4,400 $0 Total $48,400 $48,400 $42,900 $26,400 $0 Qualifying EPs must be employed by the qualifying M organization OR Be employed by, or be a partner of, an entity that through contract with the qualifying M organization furnishes at least 80 percent of the entity's Medicare patient care services to enrollees of the qualifying M organization. M EPs must furnish at least 80% of their Medicare-related professional s services to enrollees of the M organization and must furnish, on average, at least 20 hours per week of patient care services. M Payment Schedule is the same as the FFS schedule.
Computation and Payments In calculating qualifying M EP incentive payments, only covered professional services provided to enrollees of M plans offered by qualifying M organizations will be considered ny service reimbursed by Medicare FFS will not be included in the calculation Registration will begin early 2011 EP must be enrolled in Medicare, Medicare M, or Medicaid EP must be enrolled in the CMS Provider Enrollment, Chain and Ownership System (PECOS) EP must have a National Provider Identifier (NPI) Thank you for joining us! 24