MEANINGFUL USE - WHAT YOU NEED TO KNOW TO GET STARTED

It’s time to get started on selecting your Meaningful Use partner – one that has the expertise and will be with you for every single stage of Meaningful Use. 

Make your partner:

BASICS:

In order to participate in the EHR (Electronic Health Records) Incentive Program, a physician must, on a basic level:

• Qualify as an Eligible Professional (EP) under the Medicare or Medicaid EHR Incentive program
• Adopt an ONC-ATCB (Authorized Testing and Certification Body of the Office of the National Coordinator for Health Information Technology) or “Meaningful Use” certified EHR
• Use that EHR “meaningfully” as defined by CMS

In order to qualify to receive Meaningful Use incentive payments, a provider MUST participate in either the Medicare OR Medicaid EHR Incentive Program.  Providers can only participate in one program, although they will have a one-time option to switch programs.  Providers will need to register for the program in which they wish to participate.

In order to qualify as an Eligible Professional (EP) under Medicare, providers must be doctors of medicine or osteopathy, podiatrists, optometrists or chiropractors.

In order to qualify as an Eligible Professional (EP) under Medicaid, providers must be physicians, certified nurse-midwives, nurse practitioners or physician assistants (PAs) working in a FQHC (Federally Qualified Health Center) or rural health clinic lead by a PA.

In order to participate in the EHR Incentive Program and EP must register.  You will need to register for the program in which you wish to participate.  Medicare and initial Medicaid registration can be found at http://cms.gov/EHRIncentivePrgrms.com.  Additional registration may be required with your state’s Medicaid program if you are electing to participate in the Medicaid EHR Incentive Program.

There are THREE main components:

1. Use of a certified EHR in a meaningful manner, such as e-Prescribing
2. Use of a certified EHR technology for electronic exchange of health information to improve quality of healthcare, and;
3. Use of a certified EHR technology to submit clinical quality and other measures.

A provider cannot earn incentive payments from both Medicaid and Medicare programs at the same time.  An EP may switch programs once and only once; EP’s in a group practice can mix and match.

Meaningful Use requirements WILL change over time.  Providers will be required to meet three states of Meaningful Use; each stage will add new requirements to the previous ones.

Stage 1:  is well-defined now and applies to 2011 and 2012
Stage 2:  focusing on advanced clinical processes, begins in 2013
Stage 3:  focusing on improved outcomes, will start in 2015.
Stages 2 and 3 will be further defined and finalized in future rules

Demonstrating Meaningful Use involves meeting 25 objectives / measures.  The EP must meet 15 Core Objectives and five Objectives from a menu of 10, with one of those five being a public health objective.  Also, demonstrating Meaningful Use involves meeting six of 44 Clinical Quality Measures.  And EP must meet the three Core measures, or substitutes with Alternative Core measures, and select and meet an additional three Clinical Quality Measures from the menu set of 38.

For additional information, please see (American Medical Associating) AMA resource for a complete listing of the clinical performance measures. 

Reporting

Medicaid requires only that an EP “Adopt, Implement or Upgrade” in the first year.  An EP must Adopt a certified EHR, Implement a certified EHR, or Upgrade to a certified EHR.  Medicare requires that you report Meaningful Use each year (90 days in Year One, full year reporting for Years 2 through 5).

INCENTIVES

The maximum incentive amount for most providers under Medicare is $44,000. The maximum incentive amount for most providers under Medicaid is $63,750.

It pays to adopt early!  Under Medicare, a provider can earn a maximum or $44,000 in incentive payments over a five year period, including $18,000 for those adopting in 2011 and 2012.  Under Medicaid, a provider can earn a maximum of $63,750 in incentive payments over a six year period, including $21,250 in the first year of adoption.  Providers have already started receiving payments! 

PENALTIES

If an EP elects NOT to participate in the EHR Incentive programs, he or she WILL be penalized under the Medicare Incentive Program guidelines.  A physician who accepts Medicare patients and does not become a meaningful user will be penalized for lack of use starting in 2015; this will occur through reduced or omitted Medicare claim payments, increasing in subsequent years of non-use.

The first year in which total available incentive amounts are reduced under Medicare is 2013.  The first year in which penalties start under Medicare is 2015.