The Centers for Medicare & Medicaid Services (CMS) has developed two incentive programs to encourage eligible hospitals and health care professionals to achieve Meaningful Use of electronic health records.
How the programs work
Providers first must register for the Medicaid or Medicare incentive program, depending on their patient population and other criteria. Some providers are eligible for both programs and will have to evaluate the pros and cons of each before choosing. CHITREC can help with this process. Read about eligibility requirements for each program.
Providers then work to achieve all the required measures for a specified reporting period. Eligible providers report to the government their yearly achievement of MU via a website. This is known as attestation.
Once providers attest to MU, they must continue meeting MU per program guidelines in order to keep earning incentives. Providers who accept any Medicare patients at all (regardless of their chosen incentive program) will be penalized on Medicare payments, starting in 2015, if they do not achieve MU beginning in 2013.
For more information about the Medicare and Medicaid incentive programs, click here.
Program timeline tool
Use this tool to plan out the years you will attest to Stage 1, Stage 2, and Stage 3. It will also show you how long you are required to demonstrate MU at each stage, and the maximum incentive payments you can receive.
Incentive payments and timelines
The Medicare and Medicaid programs have different payment amounts and schedules. In both, incentives are paid annually.
Providers participating in the Medicare program can earn up to the maximum of $44,000 over five years. To receive this maximum incentive payment, providers must begin in 2012. If you haven’t started yet, you are now eligible to receive up to $39,000. The last year to start is 2014, and the Medicare program ends in 2016.
The maximum payment for the Medicaid EHR Incentive Program is $63,750. To get the full amount, providers must attest for six years. The latest they can start and still receive the full amount is 2016.
Payment adjustments and bonuses
For 2015 and later, eligible professionals that do not attest to Meaningful Use as part of the Medicare or Medicaid program will have a payment adjustment (penalty) to any Medicare services reimbursements they bill for. There are no payment adjustments for Medicaid reimbursements.
Eligible providers in Health Professional Shortage Areas (HPSAs) who accrue the maximum allowable charges under the Medicare program get a 10% bonus incentive payment when they participate in the Medicare or Medicaid incentive program.
For 2014 only
In 2014, all providers regardless of their stage of MU are required to demonstrate MU for only a 3-month reporting period. CMS is permitting this one-time 3-month reporting period in 2014 so providers who must upgrade to 2014 Certified EHR Technology will have adequate time to implement their new Certified EHR systems.
- For Medicare providers, this 3-month reporting period is fixed to the quarter of either the fiscal (for eligible hospitals and CAHs) or calendar (for EPs) year in order to align with existing CMS quality measurement programs, such as the Physician Quality Reporting System (PQRS) and Hospital Inpatient Quality Reporting (IQR).
- The 3-month reporting period is not fixed for Medicaid EPs and hospitals that are only eligible to receive Medicaid EHR incentives.
Qualifying for the Incentive Programs
Requirements vary based on whether the applicant is an “eligible professional” or eligible hospital.” This table summarizes eligibility requirements:
For Medicaid, there are also patient volume requirements to qualify:
For questions about eligibility, contact us and someone from CHITREC will be able to help you out.
Which incentive program is best for me – Medicare or Medicaid?
This decision will be based on a number of factors, especially patient mix. You may qualify for both the Medicare and the Medicaid incentive programs, but you must choose to participate in only one program. Generally, if you qualify, the Medicaid program will return more money. Some key differences are provided:
After initially registering for the Medicare or Medicaid program, eligible professionals will be allowed to change their selection only once during payment years 2012 through 2014.
How CHITREC helps
Step 1: Contact CHITREC about working with our expert staff. Visit Programs for info on how we work with primary care providers and specialists.
Step 2: With CHITREC’s guidance, determine which incentive program is best for you.
Step 3: Utilize CHITREC to assess your practice and help you develop a Meaningful Use action plan.
- CMS Electronic Health Record Incentive Programs page
- CMS EHR Incentive Programs FAQs (Updated)
- An introduction to the Medicare EHR Incentive program for eligible professionals
- An introduction to the Medicaid EHR Incentive program for eligible professionals
- Video overview of the EHR Incentives Programs from the National Institutes of Health
- Government site for registration or attestation for EHR Incentives Program
- Official EHR Incentive Programs educational materials