The Health Information and Technology for Economic and Clinical Health Act of 2009 established the electronic health records incentive program.
Beginning in 2011, financial rewards are available through either Medicare or Medicaid for eligible professionals who put electronic health record technology in place.
Under Medicare, eligible professionals may earn up to $44,000 in incentive payments during a five-year period, and under Medicaid, as much as $63,750 is available to eligible professionals for a six-year period.
HITECH and Medicare
Under Medicare, eligible professionals are defined as nonhospital-based doctors of medicine, osteopathy, dental surgery or dental medicine, podiatry and optometry, or chiropractors.
Eligible professionals are considered hospital-based if 90 percent or more of their services are performed in hospital or emergency room settings. To participate, these professionals must use certified electronic health record technology for purposes including submission of clinical quality measures and the electronic exchange of health information to improve quality of care.
The Medicare incentive payment is equal to 75 percent of Medicare allowable charges for covered services furnished by the eligible professional in a year. Incentive money is not available after 2016.
For eligible professionals whose first Medicare payment year is 2011 or 2012, the maximum payment for each of the first five years will be $18,000, $12,000, $8,000, $4,000 and $2,000, respectively. For eligible professionals whose first payment year is 2013 or 2014, the maximum payment for the first year is $15,000 or $12,000, respectively. For eligible professionals who don’t become meaningful users under Medicare or Medicaid by 2015, the government will make Medicare payment adjustments, reducing the fee schedule amount for professional services by 1 percent in 2015, 2 percent in 2016, 3 percent in 2017 and between 3 percent and 5 percent in following years.
Medicaid stipulations
Each state is required to submit a state Medicaid health information technology plan to the Centers for Medicare and Medicaid Services for review and approval before the incentive plan can be implemented. Missouri created a draft of its plan on Oct. 5.
Under Medicaid, eligible professionals qualify for incentive payments if they adopt, implement, upgrade or demonstrate meaningful use during the first year of participation, and they must show meaningful use for additional years of eligibility.
Eligible professionals through Medicaid are defined as physicians – primarily doctors of medicine and osteopathy – nurse practitioners, certified nurse midwives, dentists or physicians’ assistants who provide services in federally qualified health centers, or rural health clinics led by physician assistants. Just as with Medicare, eligible professionals may not be hospital-based.
Also, under Medicaid, patient volume thresholds for care provided to needy individuals must be met for eligibility.
The first-year payment for eligible professionals through Medicaid is $21,250, and eligible professionals must join the program by 2016 to obtain incentive money available under Medicaid through 2021.
Eligible professionals must choose between Medicare or Medicaid to access HITECH funds, but they may change their minds once before 2015 and may reassign payment to the group practice if desired.
Lynne Haggerman, M.S., is president/owner of Lynne Haggerman & Associates LLC, a Springfield firm specializing in management training, retained search, outplacement and human resource consulting. She can be reached at lynne@lynnehaggerman.com.[[In-content Ad]]
