EHR Incentive Program: Overview and Analysis

-->September 6, 2012Billing & Compliance Alerts

    EHR Incentive Program: Overview and Analysis
    by: Justin Vaughn, CPC, M.Div
    Director of Compliance


    As a follow-up to last week’s client alert on the recently released Final Rule for Meaningful Use – Stage 2, we would like to offer a fresh overview of the EHR Incentive Program, outlining its key components and requirements.

    As stated in last week’s alert, the Centers for Medicare and Medicaid Services (CMS), has extended to anesthesiologists, in particular, the unique opportunity to apply for an exemption from the program—which in turn allows the applicant to avoid the escalating penalties for non-participation.  However, what if the anesthesiologist wants to participate?  What if the anesthesia provider is willing to endure the complexities and hardships inherent in the program in order to have a shot at pocketing the 5-figure incentive payment?  For those intrepid individuals, the following highlights are presented:

    [NOTE:  There are two versions of the program—Medicare and Medicaid.  You can only choose to participate in one.  As many will not qualify for the Medicaid version, the following only pertains to the Medicare version.]

    Program Basics

    1. The program starts and ends with a “certified” electronic health record (EHR).  Without this, there is no possibility of participation.  You will need to verify with your facility’s IT staff or EHR vendor as to whether or not the EHR is certified, i.e., meets CMS’s complicated criteria for program functionality.
    2. You do not have to own, lease, or make any capital investment in, the EHR or its software.  You simply must adopt and “meaningfully use” the EHR.
    3. Non-physician practitioners (NPPs), such as CRNAs, NPs and PAs, cannot participate.  The program is primarily for physicians.
    4. The incentive payment is potentially $44,000, paid out over 5 years to each successful participant.
    5. To begin participation, you must first register for the program.  Click on this link to learn more about the registration process.
    6. You must then demonstrate “meaningful use” of the certified EHR during the reporting period by meeting 15 core objectives and 5 menu objectives—each of which contains a “measure” to meet.  In addition, you must report on 6 clinical quality measures.
    7. The reporting period:  In your first year of participation, the reporting period is any consecutive 90-day period, as long as it takes place wholly within the same calendar year (Jan-Dec).  For all subsequent years, the reporting period is the entire year (Jan 1-Dec 31).  In order to have an opportunity to receive the full $44,000 incentive payment, providers must have begun to meaningfully use the EHR by Oct 1, 2012.  Again, you must first register for the program.  Those beginning the program next year will be eligible for a maximum payout of $39,000.
    8. There are 3 stages to the program.  We are currently in Stage 1.  Stage 2 will begin in 2014—assuming the provider begins participating in 2012 or 2013.  With each successive stage, the criteria for successful completion is potentially more challenging.  The recently released final rule deals primarily with the requirements of Stage 2.
    9. At the conclusion of the reporting period, a participating provider must “attest” that he/she met the meaningful use requirements.  For more on the attestation process, please go to the aforementioned link.
    10. Financial penalties will be assessed by CMS beginning in 2015 against any provider who is deemed eligible to participate, but who fails to do so, or fails to obtain an exemption.

    In Summation

    There are a myriad of other facts concerning the EHR Incentive Program.  Our purpose herein is to simply apprise you of the latest news concerning this CMS initiative.  Specifically, we wanted to underscore, in these last two alerts, the following key facts:

    • Participation in the program must begin by Oct 1, 2012 to receive the full incentive payout.
    • For those deemed eligible to participate, but fail to do so, financial penalties begin in 2015, and will be based on 2013 and 2014 participation.
    • CMS has recently recognized that in the current Stage, it will be exceedingly difficult (though not impossible) for anesthesiologists to meet the program requirements, and has therefore offered to these providers up to 5 years of exemption from the escalating penalties.  The provider must apply for the first exemption by July 1 of 2014.  More details on the application process will be forthcoming in future alerts.

    The decision to participate or seek exemption is up to you.  Medac remains ready to assist you in the deliberative process.  Please let us know if we can provide further clarification on this program.

    The information presented herein reflects general information that is current as of the date it was first published.  In light of changes that may occur in the health care regulatory and compliance environments, the author’s presentation of this information might become outdated.  Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.