Medical Practice Management

Who is Eligible?

Physicians who demonstrate “meaningful use” of a certified EHR, implemented by January 1, 2011, are eligible for funding. Under Medicare the following providers are eligible: MD/DO, DDS/DMD, DPM, OD, DC. Under Medicaid the following providers are eligible: Physicians, Pediatricians, Dentists, Midwives, Nurse Practitioners and Physician Assistants. Hospital based physicians are excluded.

How are the Medicare incentives paid?

Incentives will be paid out over a 5-year period. Thereafter, healthcare professionals will receive maximized incentive payments for HIT adoption by embracing a qualified electronic health records by 2011 or 2012. After 2014, there will be no incentive payment, and potential penalties may be assessed from then on.

If Adopted by:	2011*	2012*	2013*	2014	2015
Year 1	$18,000
Year 2	$12,000	$18,000
Year 3	$8,000	$12,000	$15,000
Year 4	$4,000	$8,000	$12,000	$12,000
Year 5	$2,000	$4,000	$8,000	$8,000
Year 6	$0	$2,000	$4,000	$4,000	$0
Total	$44,000	$44,000	$39,000	$24,000	$0
*Eligible Professionals in a designated health professional shortage area can receive a 10% increase.

How are the Medicaid incentives paid?

The same eligible professional requirements of “meaningful use” of a “certified EHR Technology” must be met. The difference between Medicare incentives and Medicaid incentives is that “meaningful use” for Medicaid is State-approved, and acceptable to the Secretary of HHS. Payments may begin in 2011 and will not exceed 85% of the net average allowable costs for the certified EHR technology, including support, maintenance, and training. Also, unlike Medicare, there will be no reduction in Medicaid reimbursement for non-adoption.

Eligible Provider Type	Percent of Patient Volume	Incentive
Non-hospital Based (e.g. Family Medicine)	At least 30% Medicaid	85% of net average allowable costs for EHR
Non-hospital Based Pediatrician	At least 20% Medicaid	85% of net average allowable costs for EHR
FQHC or Rural Health Clinic Provider	At least 30% Medicaid	85% of net average allowable costs for EHR
Children’s Hospitals or Non-Children’s Acute Hospitals	At least 10% Medicaid	Max. Amount permitted for the provider involved.

How do I qualify?

	Medicare	Medicaid
Eligible Provider Types	MD, DO, DDS, DMD, DPM, Optometrists, DC	Physicians, Dentists, Midwives, Nurse Practitioners, Physician Assistants leading a FQHC/RHC
EHR Reporting Periods	Year 1: any continuous 90–day period within the calendar year; Years 2–4: the entire calendar year	Year 1: any continuous 90–day period within the calendar year; Years 2–4: the entire calendar year
Meaningful Use Criteria	Stage 1: 25 objectives/measures	Not required the first year. Thereafter, Medicare criterion apply and/or states may add additional criteria
Volume Threshold Requirement	None required, but payment is capped at 75% of Medicare allowable received during the EHR reporting period	Medicaid encounters must represent 20% for pediatricians; 30% for FQHC/RHCs; and, 30% for all others

How do I get paid?

	Medicare	Medicaid
Payment Year	Calendar year (CY) beginning January 1, 2011	Beginning 2010 for adoption, implementation, or upgrading of EHR. Meaningful use beginning CY2011
Reporting Requirements	CY2011 – no electronic submission, results reported through attestation CY2012 – electronic submission to CMS required	TBD by each state
Incentive Opportunity	Up to $48,400 per provider by NPI; additional 10% for providers in shortage areas; Incentives end after 2014	Up to $63,750 per provider by NPI; Incentives end after 2016
Penalty for Non–Adoption	Medicare payment adjustment decrease to 99% of allowable in 2015; 98% of allowable in 2016; 97% of allowable in 2017	No penalty for non–adoption
Incentive Payment Administration	Through Medicare Administrative Contractors to the TIN	Through states to the TIN