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Aug 4 2010

Federal EHR incentives: A quick guide

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President Obama signed the American Recovery and Reinvestment Act of 2009 (ARRA) in February 2009. The part of the law known as the HITECH Act promotes the meaningful use of electronic health records (EHR) by providing financial incentives to certain healthcare professionals. Below is a review of the incentive programs’ key components.

What agencies are providing financial incentives?
Medicare and Medicaid will each have separate incentive programs.

What types of healthcare professionals may receive incentive payments?
For the Medicare program, physicians (whether MDs or DOs), podiatrists, optometrists and chiropractors may all claim incentives. For the Medicaid program, eligible professionals include physicians (pediatricians have special eligibility and payment rules), dentists, nurse practitioners and physician assistants who treat patients in a rural health clinic or Federally Qualified Health Center that is led by a PA.

Can I claim incentives through both programs?
No. Eligible healthcare professionals may participate in only one incentive program.

How much money can an eligible professional receive?
Participants who meet all requirements for EHR incentives can receive up to $44,000 over five years in payments from Medicare, or they may receive up to $63,750 over six years from Medicaid.

Can any physician receive incentive payments?
No. Hospital-based physicians who perform substantially all of their services in an inpatient hospital setting or emergency room only do not qualify. The final meaningful use rule clarifies questions about hospital-based providers in ambulatory settings.

When will incentive payments begin?
Registration by eligible providers who wish to receive the Medicare or Medicaid payments will begin in January 2011. A registration link will be available at Attestations for the Medicare program will start in April 2011, and Medicare incentive payments will begin in mid-May 2011. States will initiate their incentive programs on a rolling basis pending CMS approval of the State Medicaid HIT plan.

When will incentive payments stop?
Medicare will make no incentive payments for EHR use after 2016, so apply ASAP if you intend to claim the maximum incentive under Medicare. Medicaid will make incentive payments beyond 2016, but eligible professionals may not receive payments for more than six years.

What must a medical practice do to qualify for incentives, other than adopt EHR?
Practices must demonstrate “meaningful use” of EHR, meet requirements for submitting information on clinical and health information quality measures and be able to demonstrate interoperability with other healthcare facilities to receive payments. All of these criteria must be met to receive payments. The final rule on meaningful use sets up a two track approach that divides objectives into required core objectives on which all providers must report and a menu of set objectives from which providers can choose to report what is most important to them.

I’m not sure what “meaningful use” entails. How can I ensure I qualify for payments?
DHHS finalized the rules governing the EHR incentive programs on July 13, 2010. The final rule defines meaningful use and specifies the steps that healthcare professionals must take to qualify. CMS has created a fact sheet on the rules and program standards at

I can’t afford to invest in EHR right now, even with incentive payments. Are there consequences for sticking with paper records?
Yes. Incentive payments are a carrot to encourage adoption of certified EHR systems, but there’s also a stick for those who don’t. Healthcare professionals who do not demonstrate “meaningful use” of EHR by 2015 will receive a Medicare fee cut of up to 5 percent.

Source: Centers for Medicare & Medicaid Services
Did you know?
The NCMB recently amended its position statements titled Medical Record Documentation and Retention of Medical Records to address electronic medical records (EMR).

The changes include language that advises licensees to be sure records accurately reflect elements of proper documentation and that confidentiality is preserved when EMRs are discarded or destroyed.

View these statements.

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