Understanding HITECH’s Meaningful Use

The Centers for Medicare & Medicare Services (CMS) introduced rules to implement provisions of ARRA to provide incentive payments for the meaningful use of certified Electronic Health Record (EHR) technology. Meaningfull use has an impact on HIPAA and HITECH mandates - as we will review at the end of this blog update. There are two incentive programs introduced as a direct result of HITECH’s Meaningfull Use program. The Medicare EHR incentive program provides incentive payments to Eligible Professionals (EPs), eligible hospitals, and Critical Access Hospitals (CAHs) - meaningful users of certified EHR technology. The Medicaid EHR incentive program provides incentive payments to EPs and hospitals to adopt, implement, or upgrade certified EHR technology or for meaningful use in the first year of their participation in the program and for demonstrating meaningful use during each of the subsequent 5 years.

Medicare Incentive Program

Let’s look first at some important requirements associated with the Medicare Incentive Program for meaningful use.

• Eligibility - A Medicare EP is a doctor of medicine or osteopathy, doctor of dental surgery/dental medicine, doctor of podiatric medicine, optometry or chiropractor
  • Qualifying EP is one who demonstrates meaningful use for the EHR reporting period
• EP can receive EHR incentive payments for upto 5 years, starting in 2011; 2014 is last year EP can begin receiving incentive payments
  • Maximum amount under the Medicare program is $44,000
  • 10% bonus applicable for shortage areas; maximum payment is $48,400

First year EP applies for and receives an incentive payment, the EHR Reporting Period is 90 days (continuous period within the year); after 1^st year, the EHR reporting period = calendar year.

Medicaid Incentive Program

Now let’s review some important requirements associated with the Medicaid Incentive Program for meaningful use.

• Eligibility - Physicians, dentists, nurse practitioners, certified nurse midwives, physician assistants practicing predominantly in a FQHC/RHC that is directed by a physician assistant
  • Must annually meet patient volume thresholds (total # of Medicaid patient encounters/All patient encounters = 30% or higher except pediatricians (20%); Must not be hospital based
• EP can receive EHR incentive payments starting in 2010
  • Maximum amount under the Medicaid program is $63,750
• States must verify eligibility of & disburse payments to Medicaid EPs
• EPs must select one state from which to receive their payments
• EPs must select one program - Medicare or Medicaid to receive incentive payments - not both

So for example, physicians are eligible to receive up to $44,000 in total incentives per physician from Medicare for “meaningful use” of a certified Electronic Health Record (EHR) starting in 2011. However, these EHR initiatives are coupled with strong mandates for privacy and security compliance that must be addressed.