Basic Overview of Medicare and Medicaid EMR Incentive Programs

Eligible Professionals will need to determine which program they are going to choose to participate in. To see which program you are eligible for, you can click here or click the "Are You Eligible?" link above.  EPs can switch programs only onetime after they have begun an incentive program.

  • Reporting is done through attestation currently
  • Objectives and Clinical Quality Measures must be met and reported
  • Reporting may be yes/no or numerator/denominator attestation
  • To meet certain objectives/measures, 80% of patients must have records in the certified EHR technology
  • Registration for the incentive program will begin in January 2011 through CMS (not all state Medicaid programs will be in place until later in 2011)

    You will need the following for the registration process:

    • If you are registering as an eligible hospital or Medicare eligible professional, you will need an approved enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS).  Medicaid eligible professionals are not required to be enrolled in PECOS. 
      • If you do not have a record in PECOS, you should still register for the Medicare and Medicaid EHR Incentive Programs. (Please note –your eligible hospital or Medicare eligible professional registration status will remain in an “issue pending” status until you have an active enrollment record in PECOS.)
    • A National Provider Identifier (NPI)
    • A National Plan and Provider Enumeration System Identity and Access Management ID and password for the individual provider
    • A Payee Tax Identification Number (if you are reassigning your benefits)
    • A Payee NPI (if you are reassigning your benefits)

Meaningful Use Requirement Timelines

First Payment Year Stage of Meaningful Use
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
2011 1 1 1 2* 2 3 3 TBD TBD TBD TBD
2012   1 1 2* 2 3 3 TBD TBD TBD TBD
2013     1 1* 2 2 3 3 TBD TBD TBD
2014       1* 1 2 2 3 3 TBD TBD
2015         1 1 2 2 3 3 TBD
2016           1 1 2 2 3 3
2017             1 1 2 2 3

 *3-month quarter EHR reporting period for Medicare and continuous 90-day EHR reporting period (or 3 months at state option) for Medicaid EPs. All providers in their first year in 2014 use any continuous 90-day EHR reporting period.

**First year Medicare and Medicaid providers must complete 90 days of Meaningful Use before Oct. 1, 2014 to avoid the 2015 Medicare payment adjustment of 1%.

Medicare Incentive Program

The Medicare Incentive Program is coordinated, implemented, and reported on a federal level. This program is consistent for all EPs in all states.  You can click here to visit the CMS website regarding the full details of the Medicare Incentive Program.

Program overview:

  • Eligible Professionals (EPs) could earn up to $44,000 over 5 years (must be consecutive years)
  • Registration begins on January 3, 2011 click here  (MDsuite Certification Number: 30000002DJGYEAQ)
    • Users registering or attesting on behalf of an EP must have an Identity and Access Management System (I&A) web user account (User ID/Password) and be associated to the EP's NPI. If you are working on behalf of an EP(s) and do not have an I&A web user account, please visit https://nppes.cms.hhs.gov/NPPES/IASecurityCheck.do to create one.
  • Reporting period is 90 days for first year and one year subsequently
  • EPs must implement no later than 2012 to receive the maximum incentive payment
  • 2015 and later, EPs not demonstrating Meaningful Use with a Certified EMR will have Medicare payment adjustments

Medicaid Incentive Program

The Medicaid Incentive Program is coordinated, implemented, and reported on the state level.  The Medicare program serves as guidelines but states can make changes and implement other requirements.  Please check with your state regarding their full details and guidelines. Not every state has their registration program ready at this time; click here to see the status of the states. You can click here to read the full details of this program on the CMS website.

Program Overview:

  • Voluntarily offered by individual states, can begin as early as 2011
  • First year's incentive payment only require adoption, implementation (EPs do not have to meet meaningful use during the first year)
  • EPs can receive up to $63,750 over the 6 years they choose to participate in the program (can be non-consecutive years)
  • No payment adjustments under the Medicaid program

 

 


 

Note: All information provided is intended to be a helpful overview.  Please visit the CMS website for the written law and regulations.

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