CAH Method II Physicians get eligibility to EHR Incentive Program

In a letter dated January 9, 2013 from American Hospital Association (AHA) Executive VP Rick Pollack to Centers for Medicare & Medicaid Services (CMS) Acting Administrator Marilyn Tavenner, the organization requested CMS to step up to solving the previously acknowledged “flaw” in Critical Access Hospital (CAH) Method II providers. The flaw was excluding these providers from participation in the CMS EHR Incentive programs.

The AHA has been the driving force on changing the ineligibility of this group of providers in outpatient departments of CAHs from the CMS EHR Incentive programs. The ineligible providers all submit Medicare claims using Method II where the CAH bills on behalf of the provider for those services covered under the Medicare Physician Fee Schedule. But the providers have been defined incorrectly as “hospital-based” providers which have never been eligible to participate in the programs. Because of this billing method, systems at CMS were not able to track the individual provider’s service charges making it impossible to calculate percentage incentive payments. CMS is now stating they are implementing the changes necessary to acquire the information needed to include them in the Incentive Program.

CMS has now published a new fact sheet, CAH Method II Physician Participation in the Medicare EHR Incentive Program outlining how these physicians are eligible and can participate in the EHR Incentive programs. The CMS systems are being changed to incorporate National Provider Identifiers (NPI) and enable calculations of individual provider payment information. Incentive payments are scheduled to be issued beginning in 2014 for the new eligible professionals, CAH method II physicians. Physicians can begin participation in the program, with stage 1 objectives and a 90 day reporting in 2013 calendar year. Attestation will begin in 2014 when system changes are expected to be completed. The maximum Medicare incentive for the CAH method II physicians is $39,000 if they begin reporting in 2013. Physicians will also be subject to payment adjustments beginning in 2015 according to the HITECH Act.