EHR Stimulus
Do You Qualify?

Medicare

To be eligible for the payment incentives, providers must:

1. Use a certified EHR in a meaningful manner;
2. Exchange health information to improve the quality of care
3. Report on clinical quality measures
4. Meet these requirements by the 2014 payment year, although those ready by 2011-2012 will earn the most
5. Be a practicing MD, DO, DDS, DMD, DPM, OD, or Chiropractor

Medicare Advantage (MA)-Affiliated Physicians: Physicians employed by a MA organization are eligible if the organization attests that they are meaningful EHR users. A contracted physician is eligible if he/she furnishes at least 80% of the entity’s Medicare patient care services; at least 80% of his/her services are provided to the entity’s enrollees; and provides at least 20 hours per week of patient care service.

Medicaid

To be eligible for the payment incentives, providers must:

1. Be an eligible professional that is not hospital-based and has at least 30% of patient volume attributable to Medicaid; or
2. Be a pediatrician, who is not hospital-based and at least 20% of the volume is attributable to Medicaid (These physicians will be eligible for two-thirds of the indicated payments); or
3. Practice predominantly in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) and have at least 30% of patient volume attributable to needy individuals

To receive Medicaid incentives in the initial year, an EP only needs to demonstrate that they have engaged in efforts to “adopt, implement, or upgrade certified EHR technology” but by the second year they need to show meaningful use of the EHR.

Medicare

Beginning with professional services provided in 2011, physicians who adopt and use electronic health records (EHRs) to improve care may receive to up to $44,000 over five years if they have at least $24,000 in Medicare allowed charges per year.

Incentive payments would be equal to 75% of the allowed charges for all covered professional services furnished each year up to a maximum payment as shown in the following table:

Maximum Medicare Incentive
First Year of Meaningful Use of EHR

There will be no incentive payments for those who reach meaningful use after 2014 and penalties will begin in 2015

Eligible professionals predominantly furnishing services in a health professional shortage area will be eligible for an additional 10% maximum incentive payment each year.

Medicare Penalties

If the eligible professional has not demonstrated “meaningful use” of their EHR by 2015, the fee schedule for furnished services will be reduced by 1% each year beginning in 2015, to a maximum reduction of 3%. Hardship exceptions may apply.

Medicaid

Beginning in 2011, states will pay eligible Medicaid providers up to $63,750 (reduced by payments from any other sources) for certified EHR technology and support services including maintenance and training necessary for adoption and operation. Incentives may not exceed:

Year 1: $ 21,500. per provider

Subsequent Years: $8,500 per provider, for up to five years, but no later than 2021.

If a provider has completed adopting, implementing, or upgrading such technology prior to the first year of payment, #1 & #2 above will still apply.

This translates to a maximum payment of:

Please ask your NCG Medical representative about your specific incentive amount if you received payments for EHR technology or support services from other sources. Otherwise, the maximum incentives above apply.

There will be no incentive payments after 2021.