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Most Frequently Asked Questions

Eligibility Requirements for Professionals Medicare and Medicaid Incentive Program Basics What is "Meaningful Use"? What are "Clinical Quality Measures"?
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Overview

The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Electronic Health Record (EHR) or Electronic Medical Record (EMR)?

Sometimes people use the terms "Electronic Medical Record" or "EMR" when talking about Electronic Health Record (EHR) technology. Very often an Electronic Medical Record or EMR is just another way to describe an Electronic Health Record or EHR, and both providers and vendors sometimes use the terms interchangeably. For the purposes of the Medicare and Medicaid Incentive Programs, eligible professionals, eligible hospitals and critical access hospitals (CAHs) must use ¬certified EHR technology. Certified EHR technology gives assurance to purchasers and other users that an EHR system or module offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria. Certification also helps providers and patients be confident that the electronic health IT products and systems they use are secure, can maintain data confidentially, and can work with other systems to share information.


Eligibility Requirements for Professionals

  • Incentive payments for eligible professionals are based on individual practitioners.
  • If you are part of a practice, each eligible professional may qualify for an incentive payment if each eligible professional successfully demonstrates meaningful use of certified EHR technology.
  • Each eligible professional is only eligible for one incentive payment per year, regardless of how many practices or locations at which he or she provide services.
  • Hospital-based eligible professionals are not eligible for incentive payments. An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place Of Service code 21) or emergency room (Place Of Service code 23) setting.

Who is an Eligible Professional under the Medicare EHR Incentive Program?

Eligible professionals under the Medicare EHR Incentive Program include:

  • Doctor of medicine or osteopathy
  • Doctor of dental surgery or dental medicine
  • Doctor of podiatry
  • Doctor of optometry
  • Chiropractor

Who is an Eligible Professional under the Medicaid EHR Incentive Program?

Eligible professionals under the Medicaid EHR Incentive Program include:

  • Physicians (primarily doctors of medicine and doctors of osteopathy)
  • Nurse practitioner
  • Certified nurse-midwife
  • Dentist
  • Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.

To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet one of the following criteria:

  • Have a minimum 30% Medicaid patient volume*
  • Have a minimum 20% Medicaid patient volume, and is a pediatrician*
  • Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals

* Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria.

Eligible for Both Programs?

Eligible professionals eligible for both the Medicare and Medicaid EHR Incentive Programs must choose which incentive program they wish to participate in when they register. Before 2015, an eligible professional may switch programs only once after the first incentive payment is initiated. Most eligible professionals will maximize their incentive payments by participating in the Medicaid EHR Incentive Program.


Medicare and Medicaid Incentive Program Basics

The Medicare EHR Incentive Program

The Medicare EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology.

  • Participation can begin as early as 2011.
  • Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program. There's an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HSPA).
  • To get the maximum incentive payment, Medicare eligible professionals must begin participation by 2012.
  • Incentive payments for eligible hospitals and CAHs may begin as early as 2011 and are based on a number of factors, beginning with a $2 million base payment.
  • Important! For 2015 and later, Medicare eligible professionals, eligible hospitals, and CAHs that do not successfully demonstrate meaningful use will have a payment adjustment in their Medicare reimbursement.

Note: If you are a Medicare Advantage Plan (like an HMO or PPO), please visit our Medicare Advantage page.

Medicare EHR Incentive Payment Schedule for Eligible Professionals

Calendar Year First Calendar Year In Which the Qualifying Eligible Professional Receives
an Incentive Payment
2011 2012 2013 2014 2015+
2011 $18,000

 

 

 

 

2012 $12,000 $18,000

 

 

 

2013 $8,000 $12,000 $15,000

 

 

2014 $4,000 $8,000 $12,000 $12,000

 

2015 $2,000 $4,000 $8,000 $8,000 $0
2016

 

$2,000 $4,000 $4,000 $0
TOTAL $44,000 $44,000 $39,000 $24,000 $0

 

The Medicaid EHR Incentive Program

The Medicaid EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their first year of participation and demonstrate meaningful use for up to five remaining participation years.

  • The Medicaid EHR Incentive Program is voluntarily offered by individual states and territories and may begin as early as 2011, depending on the state.
  • Eligible professionals can receive up to $63,750 over the six years that they choose to participate in the program.
  • Eligible hospital incentive payments may begin as early as 2011, depending on when the state begins its program. The last year a Medicaid eligible hospital may begin the program is 2016. Hospital payments are based on a number of factors, beginning with a $2 million base payment.

There are no payment adjustments under the Medicaid EHR Incentive Program.

Medicaid EHR Incentive Payment Schedule for Eligible Professionals

Adoption Year
First Calendar Year In Which the Qualifying Eligible Professional Receives an Incentive Payment
2011
2012
2013
2014
2015
2016
2011
$21,250

 

 

 

 

 

2012
$8,500
$21,250

 

 

 

 

2013
$8,500
$8,500
$21,250

 

 

 

2014
$8,500
$8,500
$8,500
$21,250

 

 

2015
$8,500
$8,500
$8,500
$8,500
$21,250

 

2016
$8,500
$8,500
$8,500
$8,500
$8,500
$21,250
2017

 

$8,500
$8,500
$8,500
$8,500
$8,500
2018

 

 

$8,500
$8,500
$8,500
$8,500
2019

 

 

 

$8,500
$8,500
$8,500
2020

 

 

 

 

$8,500
$8,500
2021

 

 

 

 

 

$8,500
TOTAL
$63,750
$63,750
$63,750
$63,750
$63,750
$63,750

 


Meaningful Use

The Medicare and Medicaid EHR Incentive Programs provide a financial incentive for the "meaningful use" of certified EHR technology to achieve health and efficiency goals. By putting into action and meaningfully using an EHR system, providers will reap benefits beyond financial incentives-such as reduction in errors, availability of records and data, reminders and alerts, clinical decision support, and e-prescribing/refill automation.

Click on the links below to learn more:

  • What is Meaningful Use?
  • What are the Criteria for Meaningful Use:
  • How do I Meet Meaningful Use Requirements:
  • What are the requirements for Stage 1 of Meaningful Use (2011 and 2012):
  • What are Clinical Quality Measures:
  • What can I Learn from Meaningful Use Objectives Specification Sheets:

What is "Meaningful Use"?

The American Recovery and Reinvestment Act of 2009 specify three main components of Meaningful Use:

  • The use of a certified EHR in a meaningful manner, such as e-prescribing.
  • The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
  • The use of certified EHR technology to submit clinical quality and other measures.

Simply put, "meaningful use" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.

What are the Criteria for Meaningful Use

The criteria for meaningful use will be staged in three steps over the course of the next five years.

  • Stage 1 (2011 and 2012) sets the baseline for electronic data capture and information sharing.
  • Stage 2 (expected to be implemented in 2013) and Stage 3 (expected to be implemented in 2015) will continue to expand on this baseline and be developed through future rule making.

How do I Meet Meaningful Use Requirements?

To qualify for incentive payments, meaningful use requirements must be met in the following ways:

  • Medicare EHR Incentive Program - Eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must successfully demonstrate meaningful use of certified electronic health record technology every year they participate in the program.
  • Medicaid EHR Incentive Program - Eligible professionals and eligible hospitals may qualify for incentive payments if they adopt, implement, upgrade or demonstrate meaningful use in their first year of participation. They must successfully demonstrate meaningful use for subsequent participation years.
  • Adopted: Acquired and installed certified EHR technology. (For example, can show evidence of installation.)
  • Implemented: Began using certified EHR technology. (For example, provide staff training or data entry of patient demographic information into EHR.)
  • Upgraded: Expanded existing technology to meet certification requirements. (For example, upgrade to certified EHR technology or add new functionality to meet the definition of certified EHR technology.)

What are the requirements for Stage 1 of Meaningful Use (2011 and 2012)?

Meaningful use includes both a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals and CAHs.

For eligible professionals, there are a total of 25 meaningful use objectives. To qualify for an incentive payment, 20 of these 25 objectives must be met.

  • There are 15 required core objectives.
  • The remaining 5 objectives may be chosen from the list of 10 menu set objectives.

For eligible hospitals and CAHs, there are a total of 24 meaningful use objectives. To qualify for an incentive payment, 19 of these 24 objectives must be met.

  • There are 14 required core objectives.
  • The remaining 5 objectives may be chosen from the list of 10 menu set objectives.

What are "Clinical Quality Measures"?

To demonstrate meaningful use successfully, eligible professionals, eligible hospitals and CAHs are required also to report clinical quality measures specific to eligible professionals or eligible hospitals and CAHs.

  • Eligible professionals must report on 6 total clinical quality measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures (selected from a set of 38 clinical quality measures).
  • Eligible hospitals and CAHs must report on all 15 of their clinical quality measures.

Visit the Centers for Medicare and Medicaid Services Clinical Quality Measures to learn more about clinical quality measures for eligible professionals, eligible hospitals and CAHs.

What Can I Learn from the Meaningful Use Specification Sheets?

The Meaningful Use Objectives specification sheets for the Medicare and Medicaid EHR Incentive Programs bring together critical information on each objective to help eligible professionals and eligible hospitals/critical access hospitals understand what they need to do to demonstrate meaningful use successfully. For eligible professionals, there are a total of 25 meaningful use objectives. To qualify for an incentive payment, 20 of these 25 objectives must be met, including:

  • 15 required core objectives
  • 5 menu set objectives that may be chosen from a list of 10

Mandatory Meaningful Use Criteria

  • 1. Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.
  • 2. Implement drug-drug and drug-allergy interaction checks.
  • 3. Maintain an up-to-date problem list of current and active diagnoses.
  • 4. Generate and transmit permissible prescriptions electronically (eRx).
  • 5. Maintain active medication list.
  • 6. Maintain active medication allergy list.
  • 7. Record all of the following demographics:
    • (A) Preferred language.
    • (B) Gender.
    • (C) Race.
    • (D) Ethnicity.
    • (E) Date of birth.
  • 8. Record and chart changes in the following vital signs:
    • (A) Height.
    • (B) Weight.
    • (C) Blood pressure.
    • (D) Calculate and display body mass index (BMI).
    • (E) Plot and display growth charts for children 2-20 years, including BMI.
  • 9. Record smoking status for patients 13 years old or older.
  • 10. Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the States.
  • 11. Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule.
  • 12. Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request.
  • 13. Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.
  • 14. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.
  • Menu Meaningful Use Criteria

    Choose 5 of 10

    • 1. Implement drug formulary checks.
    • 2. Incorporate clinical lab-test results into EHR as structured data.
    • 3. Generate patient lists by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
    • 4. Send patient reminders per patient preference for preventive/follow-up care.
    • 5. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP.
    • 6. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate.
    • 7. The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.
    • 8. The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral.
    • 9. Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice.
    • 10. Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice.