EHR Incentive Program: Hardship Exception Applications Due July 1
Medicare Electronic Health Record (EHR) Incentive Program 2017 hardship exception applications are due by July 1, 2016, for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) to avoid payment adjustments.
Visit the FAQ webpage for answers to specific hardship exception questions.
2015 Meaningful Use Program Requirements
To help eligible professionals successfully participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs in 2015, CMS has posted resources on the CMS EHR Incentive Programs website.
About the EHR Incentive Programs Final Rule
On October 6, 2015 CMS released the final rule for the EHR Incentive Programs, which provides new criteria that eligible professionals, eligible hospitals, and CAHs must meet in order to successfully participate in the EHR Incentive Programs in 2015 through 2017 and Stage 3 in 2018 and beyond.
- Overview of EHR Incentive Programs
- Timeline for EHR Incentives and Penalties
- Differences between Medicare and Medicaid EHR Incentive Programs
- Eligibility Requirements for Professionals
- Understanding Meaningful Use
- Hardship Exemption
- Stages of Meaningful Use
- Tools and Resources
Overview of EHR Incentive Programs
The Medicare and Medicaid EHR Incentive Programs provide financial incentives to eligible professionals (EPs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. To receive an EHR incentive payment, providers have to show that they are “meaningfully using” their EHRs by meeting thresholds for a number of objectives.
If Medicare eligible professionals, or EPs, do not adopt and successfully demonstrate meaningful use of a certified electronic health record (EHR) technology by 2015, the EP’s Medicare physician fee schedule amount for covered professional services will be adjusted down by 1% each year.
- EHR Incentive Program: Last year to initiate participation in the Medicare EHR Incentive Program
- EHR Incentive Program: Medicare payment adjustments begin for EPs and eligible hospitals that are not meaningful users of EHR technology
- Penalties: 1% reduction in the providers’ Medicare Physician Fee Schedule (PFS)
- EHR Incentive Program: Last year to receive a Medicare EHR Incentive Payment Last year to initiate participation in Medicaid EHR Incentive Program
- Penalties: 2% reduction in the providers’ Medicare Physician Fee Schedule (PFS)
- 2017 and beyond
- Penalties: 3% reduction in the providers’ Medicare Physician Fee Schedule (PFS)
- EHR Incentive Program: Last year to receive Medicaid EHR Incentive Payment
*If less than 75% of EPs have become meaningful users of EHRs by 2018, the adjustment will change by 1% point each year to a maximum of 5%(95% of Medicare covered amount).
**No payment adjustments are planned for Medicaid providers. However, Medicaid providers who also treat Medicare patients will have a payment adjustment to Medicare reimbursements starting in 2015 if they do not successfully demonstrate meaningful use. Providers who are not eligible for the Medicare and Medicaid EHR Incentive Programs will not be subject to any payment adjustments.
There are some differences between the Medicare and Medicaid EHR Incentive Programs:
Medicare EHR Incentive Program
- Run by CMS
- Maximum incentive amount is $44,000
- Payments over 5 consecutive years
- Payment adjustments will begin in 2015 for providers who are eligible but decide not to participate
- Providers must demonstrate meaningful use every year to receive incentive payments.
Medicaid EHR Incentive Program
- Run by Your State Medicaid Agency
- Maximum incentive amount is $63,750
- Payments over 6 years, does not have to be consecutive
- No payment adjustments for providers who are only eligible for the Medicaid program
- In the first year providers can receive an incentive payment for adopting, implementing, or upgrading EHR technology. Providers must demonstrate meaningful use in the remaining years to receive incentive payments.
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
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
- 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.
Understanding Meaningful Use
Your local Regional Extension Center (REC) serves as a valuable resource to help you understand meaningful use. RECs are located in every region of the country to help health care providers select, implement, and become adept and meaningful users of EHRs. Contact your local REC to find out if you are eligible for free or reduced-price meaningful use support.
2016 Hardship Exemption information will be posted soon.
Tools and Resources for Meaningful Use
CMS has several resources located on the EHR Incentive Programs website to help EPs properly meet meaningful use and attest, including:
- A Registration & Attestation page on the CMS EHR Incentive Programs website that houses information on registration and attestation, and includes links to additional resources.
- The Meaningful Use Attestation Calculator allows EPs and eligible hospitals to determine if they have met the Stage 1 meaningful use guidelines before they attest in the system. The calculator prints a copy of each EP’s or eligible hospital’s specific measure summary.