The EHR Incentive Program, often dubbed “Meaningful Use” (MU), has been surrounded by questions and confusion among anesthesiologists and practice administrators since its inception. Currently, the majority of anesthesiologists and pain physicians are classified as an Eligible Professional (EP) under the Medicare portion of Meaningful Use and most of the public conversation is centered on that program. However, the Medicaid option offers more flexibility and financial incentive which raises the question, “How does the Medicaid EHR Incentive Program differ from the Medicare portion?”
The major differences between the Medicare and Medicaid programs of Meaningful Use center on:Provider EligibilityProvider EnrollmentFinancial IncentiveAttestation ScheduleProvider Enrollment and Eligibility
To be considered a Medicaid EP, an anesthesiologist or pain physician must perform less than 90% of their services in an inpatient setting (POS 21), but also must provide at least 30% of services to Medicaid patients. According to CMS:
Medicaid patients might be fee-for-service encounters where...
Abby Pendleton, Esq., The Health Law Partners, P.C., Southfield, MIStephanie P. Ottenwess, Esq., The Health Law Partners, P.C., Los Angeles, CAOn March 7, 2012, the Centers for Medicare and Medicaid Services (CMS) published its Notice of Proposed Rule Making (NPRM, or proposed rule) for Stage 2 user requirements for the Medicare/Medicaid Electronic Health Record (EHR) Incentive Program (“meaningful use,” or MU) in the Federal Register. 77 FR 13698.1 There is a three pronged focus to the Stage 2 criteria: standardizing data formats to dramatically simplify how information is both captured and shared across disparate IT systems in order to be better able to coordinate care with other physicians; ensuring that patients be able to access and easily download their healthcare records and images for their own use; and expanding the scope of tracked quality metrics to include specialists and to reflect and improve specific patient outcomes as well as care coordination.Although subsequent to...
Anesthesia Business Consultants, LLC (ABC) embraced a new role and filed formal comments on a “Notice of Proposed Rulemaking” with the Centers for Medicare and Medicaid Services (CMS) on May 7, 2012. The Proposed Rule would modify the requirements for physicians and hospitals to demonstrate “meaningful use” of certified Electronic Health Record (EHR) technology. Meaningful users of certified EHRs are able to earn Medicare bonuses of up to $44,000 or Medicaid bonuses of up to $63,750 per physician. Just as important, eligible professionals who fail to become meaningful users will be subject to payment penalties beginning in 2015.
Even with the best of intentions and a reasonable amount of funds to invest, very few, if any, anesthesiologists can qualify for the bonus incentives—but they may nevertheless be subject to the penalties. To earn the former and avoid the latter, a physician must comply with a set of 15 (17 in Stage...
The Affordable Care Act (ACA) requires providers including physicians to report and refund known overpayments within 60 days, or, for providers that submit cost reports, by the date the corresponding cost report is due. The parameters of this mandate are unclear, but the duty to refund overpayments exists regardless. After summarizing some of the problems with the ACA provision and with CMS’ proposed regulations implementing the statute, we will offer some practical suggestions on compliance.The refund requirement, which has been in effect since March 23, 2010 (the date the ACA became law), is vague in several important particulars. The lack of certainty, far from discouraging compliance, has left many providers, suppliers and affected health plans scrambling to find and refund overpayments within the 60-day window to avoid hefty penalties. On February 16, 2012, CMS issued a proposed rule that limited its application to Medicare payments and cleared up some, but not...
This issue of the Communiqué is a keeper. On pages 6 through 10 you will find tables that lay out clearly the Electronic Health Records (EHR) incentive program’s Stage 1 Meaningful Use objectives, the recently proposed changes to Stage 1, and the potential Stage 2 objectives, measures and exclusions as proposed by CMS in March. The objectives, translated into measures, are capabilities that your EHR must have in order for you to qualify for the incentive, which is non-negligible at a maximum of $44,000 per physician, or to avoid the penalty for non-compliance. Even though the proposed changes discussed in the Meaningful Use article by Abby Pendleton, Esq. and Stephanie Ottenweis, Esq. are likely to be different in some respects when CMS issues the final regulation later in the year, it is worth familiarizing yourself with the proposals because understanding the final versions will be that much easier.The Meaningful Use article,...