Meaningful Use FAQs

Qualifying for Incentive Payments for the use of Electronic Health Records (EHRs)

Q.  In a nutshell, what does the bill mean to the typical clinician?

A.  Medicaid:  Eligible Professionals (EP) who meet the eligibility requirements and adopt, implement, upgrade or “meaningfully use” certified Electronic Health Record technology can receive incentives of up to a maximum of $63,750 over six years.

A.  Medicare:  Eligible Professionals who meet the eligibility requirements and “meaningfully use” of certified Electronic Health Record technology can receive incentives of up to a maximum of $44,000 over five years per EP.

Q.  What is the difference between the Medicare and Medicaid EHR incentive programs?

A.  Medicaid:  EPs can opt for either the Medicare program or the Medicaid program, but not both. Medicaid is administered by the state. Payments will be made on a diminishing scale over a six year period through 2021.

A.  Medicare:  EPs Physicians can opt for either the Medicare program or the Medicaid program, but not both. Medicare is administered by the Federal government (CMS), and the size of incentive payments to EPs is connected to the amount of reimbursement that EPs receive during the same calendar year that they are attesting to meaningful use.  Payments will be made on a diminishing scale over five year period with those for Medicare through 2016.

Q.  Can an Eligible Professional (EP) receive incentive payments from both Medicare and Medicaid?

A.  Not for the same year. If an EP meets the requirements of both programs, they must choose to receive an EHR incentive payment under either the Medicare program or the Medicaid program. After a payment has been made, the EP may only switch programs once before 2015.

Q.  If an eligible professional (EP) meets the criteria for both the Medicare and Medicaid electronic health record (EHR) incentive programs, can they choose which program to participate in?

A.  Yes. EPs who meet the eligibility requirements for both the Medicare and Medicaid incentive programs must elect the program in which they wish to participate when they register. After the initial designation, EPs can only change their program selection once after they have received payment.

Q.  Are all types of clinicians in the U.S. eligible for incentive payments?

A.  Medicaid:  Physicians (MD, DO,), nurse- practitioners, physicians assistants (at FQHCs/RHCs that are PA-led), dentists and certified nurse-midwives are eligible for incentive payments.

A.  Medicare:  Medicare defines a physician to include MD, DOs, oral surgeons, chiropractors and optometrists.

Q.  How much in reimbursements do I need to file to receive a maximum incentive?

A.  Medicaid:  There is no minimum billing amount required for Medicaid. To qualify for the incentive program, 30% of your encounters within any 90-day consecutive period from the prior calendar year  must be Medicaid patients (20% if you are a pediatrician). The exception is for EPs who have more than 50% of their encounters at an FQHC or RHC, who then can meet the patient volume requirement with 30% needy individuals (Medicaid, CHIP, sliding fee scale and uncompensated care). The state of California is currently awaiting approval of their version of the Medi-Cal EHR Incentive Program from the federal government.  It should be released in early 2011.

A.  Medicare:  Just $24,000 a year in allowed Medicare charges on the Part B fee schedule will deliver a maximum annual incentive payment.  Any less reimbursement will result in an incentive payment that is calculated at 75% of your total Medicare reimbursements for that calendar year.  

Q.  How long does the EHR program need to run to qualify for the incentive payments?

A.  Medicaid:  You do not need to have a certified EHR in order to register for the Medicaid EHR Incentive Program. However, for the first year of payment, EPs must have adopted, implemented or upgraded certified EHR technology before they can receive an EHR incentive payment from the State. As an alternative to demonstrating that they have adopted, implemented or upgraded certified EHR technology, for the first year of payment, the EP may demonstrate that they are meaningful users of certified EHR technology for the 90-day EHR reporting period. However, at this time, California is only planning to accept AIU attestations from Medicaid providers, not meaningful use, as this is the minimum necessary for a Year 1 incentive payment.

A.  Medicare:  You do not need to have a certified EHR in order to register for the Medicare EHR Incentive Program. However, to receive an incentive payment under the Medicare program, you must attest that you have demonstrated meaningful use of certified EHR technology during the EHR reporting period. For the first year of payment, the EHR reporting period is 90 consecutive days within the calendar year for eligible professionals (EPs) or within the Federal fiscal year for eligible hospitals and critical access hospitals (CAHs).

Q.  Can an Eligible Professional (EP) be penalized for not utilizing an EHR by 2015?

A.  Medicare:  If Medicare EPs have not demonstrated meaningful use of certified EHR technology by 2015, their Medicare payments will be reduced by 1% in 2015; 2% in 2016; and 3% in 2017.

Q.  When would I become eligible and what is the time line for payments?

A.  Medicaid:  Payments can begin as early as 2011, as determined by each state and continue to pay on a diminishing scale over six years, through 2021. Under the Medicaid EHR Incentive Program, incentives can also be paid for the adoption, implementation, or upgrade of certified EHR technology which can qualify your practice for the first year.  Subsequently, the following year meaningful use must be maintained for 90 days and for year 3, the eligible providers must be meaningfully using their certified EHR technology for the entire 12 month period (calendar year for EPs, federal fiscal year for hospitals).

A.  Medicare:  Payments will begin in May 2011 and continue on a diminishing scale over five years through 2016.  Eligible providers who do not initiate the Medicare incentive program by 2012 will only be paid from that year through 2016, thus receiving less than the full, maximum amount over five years.

Q.  My group has three physicians. Can each physician qualify for incentive payments under the incentive programs?

A.  Medicaid:  Yes, as long as each EP meets all the eligibility requirements, e.g. has 30% of their encounters covered by Medicaid (20% if you are a pediatrician) they will each qualify for the $63,750 incentive payment over six years.

A.  Medicare:  Yes, as long as each EP meets all the eligibility requirements and each demonstrates “meaningful use” of “certified” EHR technology and reaches the minimum amount of Medicare Part B reimbursements they will each qualify for the $44,000 incentive payment over five years.

Q.  Under the Medicare and Medicaid EHR Incentive Program, who is responsible for demonstrating meaningful use of certified EHR technology, the provider or the vendor?

A.  To receive an EHR incentive payment, the EP is responsible for demonstrating meaningful use of certified EHR technology under both the Medicare and Medicaid EHR incentive programs. Please contact HITEC-LA for services.

Q.  My practice utilized an EHR system prior to the date the Stimulus Bill was signed into law. Can the providers in my practice still qualify for the incentive payments?

A.  Yes, if the solution has been certified by an Authorized Testing and Certification Body under the new ONC EHR certification rule. . Providers can check the ONC website for a list of certified products for both ambulatory and out-patient settings. You may also contact HITEC-LA for support.

Q.  Is “Meaningful Use” defined in the legislation?

A.  The final rule from the Centers for Medicare and Medicaid (CMS) Services state that eligible providers must use certified EHR technology product for at least 90-days  in the payment year and for a full twelve months in subsequent years. Eligible providers will register at the CMS website. Medicare providers will continue on the same website to attest that they  have meaningful used certified EHR technology. Medicaid providers will complete their attestations with the State Medicaid agencies.

Q.  The cost of my EHR system was only $15,000. If I qualify, will my incentive payment be limited to $15,000?

A.  Medicaid:  No.  Under the Medicaid program, an EP may qualify for the incentive for the adoption, implementation, upgrade or meaningful use of certified EHR technology regardless of cost. The incentive maximum has been set.

A.  Medicare:  No. Under the Medicare program, an EP may qualify for the incentive for having demonstrated meaningful use of certified EHR technology regardless of cost. . The incentive amounts are instead related to the amount of your Medicare Part B reimbursements. Under Medicare the maximum incentive is $44,000 over a five year period.

Q.  My practice does not currently utilize an EHR. When is the right time to start planning for an EHR implementation?

A.  Start planning now and buy your solution for its own value to your clinical practice. Technical support regarding vendor selection, privacy and security, workflow redesign and other implementation needs is available through HITEC-LA.

Q.  How will the EHR incentive payments actually be distributed to the eligible professionals?

A.  They are distributed and taxed as income to the Tax ID number that the eligible providers uses when they register at the CMS registration system for both Medicare and Medicaid’s EHR Incentive Programs, which went live on January 3, 2011.