EP Medicare Payment Adjustments in 2015

Beginning January 1, 2015, Medicare eligible professionals that do not attest successfully to meaningful use of certified technology will incur payment adjustments. The payment adjustments are mandated through the HITECH Act to begin the first day of the 2015 calendar year. CMS will determine the Medicare payment adjustments based on meaningful use data submitted prior to the 2015 calendar year. The adjustments will be applied to the providers covered services submitted through the Medicare physician fee schedule.

Only EPs that are eligible for the Medicare EHR Incentive Program are subject to payment adjustments. To determine if you are eligible for either the Medicare or Medicaid programs use the CMS eligibility widget. Those Medicaid EPs that can only participate in the Medicaid EHR Incentive Program and do not bill Medicare are not subject to these payment adjustments.

The following is guidance from CMS on Medicare payment adjustments and what year of participation in the EHR Incentive Program. EPs must also continue to demonstrate meaningful use every year after their initial year to avoid payment adjustments in subsequent years.

EPs that began participation in 2011 or 2012
EPs who first demonstrated meaningful use in 2011 or 2012 must demonstrate meaningful use for a full year in 2013 to avoid payment adjustments in 2015.

EPs that begin participation this year (2013)        
EPs who first demonstrate meaningful use in 2013 must demonstrate meaningful use for a 90-day reporting period in 2013 to avoid payment adjustments in 2015.

EPs that plan to begin participation in 2014
EPs who first demonstrate meaningful use in 2014 must demonstrate meaningful use for a 90-day reporting period in 2014 to avoid payment adjustments in 2015. This reporting period must occur in the first 9 months of calendar year 2014, and EPs must attest to meaningful use no later than October 1, 2014, in order to avoid the payment adjustments.

CMS will be considering hardship exemptions for EPs they determine to have circumstances that pose a significant barrier to their achieving meaningful use. Information on applying for hardship exemptions will be available in the future on the CMS web site. For more information on EP Medicare payment adjustments and the hardship exceptions, see the CMS Payment Adjustments and Hardship Exceptions Tipsheet.

You can also find more details for EPs on the CMS How Payment Adjustments Affect Providers Tipsheet.