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In honor of Medicare & Medicaid's 50th Anniversary

When Medicare and Medicaid programs were first signed into law on July 30, 1965, could President Lyndon B. Johnson have imagined where we are now?  Initially Medicare and Medicaid started as basic health coverage programs for Americans.   These programs have evolved over the years and in many ways, changed the way health care is delivered in the United States.

Arguably, the Medicare and Medicaid Electronic Health Care Record (EHR) Incentive Programs have most drastically changed health care delivery in the United States.  To honor Medicare & Medicaid's 50th Anniversary, we are presenting a brief list of common Meaningful Use terminology and definitions.

Meaningful Use Terminology and Definitions

  1. Meaningful Use – while most of us understand that Meaningful Use is a Medicare and Medicaid program that awards incentives for using Certified Electronic Health Record Technology (CEHRT) to improve patient care – did you know each of the 3 stages of Meaningful Use have specific objectives?  Stage 1 promotes basic EHR adoption, data capture and sharing; Stage 2 emphasizes care coordination, exchange of patient information and advanced clinical processes; and Stage 3 is largely focused on improved healthcare outcomes.
  1. Eligible Professional / Eligible Provider (EP) – Did you know Eligible Professionals differ in the Medicare and Medicaid programs? Under the Medicare EHR Incentive Program, EPs: doctors of medicine or osteopathy, doctors of dental surgery or dental medicine, doctors of podiatry, doctors of optometry, and chiropractors.  Under the Medicaid EHR Incentive Program EPs include: physicians (primarily doctors of medicine and doctors of osteopathy), dentists, nurse practitioners, certified nurse midwives, and physician assistants practicing in a Federally Qualified Health Center led by a physician assistant or Rural Health Clinic.

  1. Medicare EHR Incentive Program vs Medicaid EHR Incentive Program – what are some of the differences between Medicare and Medicaid Incentive Programs?  Generally speaking, both are similar.  However, there are major differences:
  • Under the Medicare Incentive Program, the maximum incentive for EPs is $44,000 over 5 years.  The latest start time to earn maximum incentives under Medicare was 2014.
  • Under Medicaid, the maximum incentive is $63,750 over 6 years or $42,500 for pediatricians with 20-30% Medicaid.  Under Medicaid the latest start time is 2016. 

Please be aware that those who are unable to meet program requirements will forfeit their incentive payments. And starting this year, Eligible Providers who fail to meet criteria under the program face downward payment adjustments.

  1. Attestation – what does attestation mean anyway? When you attest to something you are validating something is true.  In other words, attestation is the process an Eligible Professional (EP) or Eligible Hospital (EH) legally states through CMS that they have demonstrated Meaningful Use with Certified EHR Technology (CEHRT).

  1. EHR Incentive Programs Audits (pre-payment and post-payment audits) – pre-payment audits are random and are looking for suspicious or abnormal data.  Providers who are selected for pre-payment audits will have to present supporting documentation that validates submitted attestation data before CMS will release payment.  In addition, CMS through its contractor (currently Figliozzi and Company), will perform post-payment audits during the course of the EHR incentive programs.  If you are selected for post-payment audits you will be required to submit supporting documentation to validate submitted attestation data.

How we can help

As you can see from the five Meaningful Use terms we reviewed in this article, CMS has come a long way from its singular healthcare coverage focus of 50 years ago.  CMS describes the program as a way to encourage your organization to demonstrate the "meaningful use" of certified-EHR technology (CEHRT) with an end goal of improving patient care. Have questions about demonstrating Meaningful Use?  Reach out to HCP – we can provide information on how to demonstrate meeting thresholds on a number of objectives. We understand that demonstrating meaningful use every year to receive an incentive and avoid a Medicare payment adjustment can be challenging.  We can help.

If you have any questions about Meaningful Use or if you have any other compliance questions, please feel free to comment below or send us an email at [email protected] or reach us by phone toll-free at 855-427-0427.

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