Eligible Professionals, EHR Incentives, Meaningful Use and Penalties

We know the mantra well enough by now. “Carrots and Sticks”.  The CMS EHR Incentive programs are based on a system of incentives and penalties. We’ve now seen 11 billion dollars worth of carrots, but what about those sticks? Well, here they come. For EPs that miss the boat there will be a 1% adjustment to Medicare reimbursements that kick in January 1, 2015. The adjustment goes up by 1% until 2017 when it becomes 3%. From 2018 and until the end of time the penalties are scheduled to vary depending on whether or not 75% of EPs are meaningful users.

First let’s try and get those Medicaid EPs off the hook. CMS states “There are no payment adjustments or penalties for Medicaid providers who fail to demonstrate meaningful use.” That is almost true. There is one way that Medicaid EPs who dally could be in for a surprise (see Commandment #3 below). What will happen to those Medicare EPs that don’t behave? How and when will they fall under the shadow of penalties or as CMS likes to say “payment adjustments”?

The 8 Commandments of Meaningful Use Penalties for EPs 

1. “The HITECH Act stipulates that for Medicare EPs, subsection (d) hospitals and CAHs a payment adjustment applies if they are not a meaningful EHR user.”

2. “An EP, subsection (d) hospital or CAH becomes a meaningful EHR user when they successfully attest to meaningful use under either the Medicare or Medicaid EHR Incentive Program.”

3. “The Medicaid first year incentive based on “Adopt, implement and upgrade” is not considered meaningful use.

A provider receiving a Medicaid incentive for AIU would still be subject to the Medicare payment adjustment.”

If the Medicaid EP’s first year is 2014, and they receive incentives via A/I/U they will be facing Medicare payment adjustments effective January 1, 2015.

 4. “Payment adjustments are based on prior years’ reporting periods. The length of the reporting period depends upon the first year of participation.”

5. “To Avoid Payment Adjustments: EPs must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent  years.”

6. “EP who demonstrates meaningful use in 2014 for the first time: In order to avoid the 2015 payment adjustment the EP must attest no later than October 1, 2014, which means they must begin their 90 day EHR reporting period no later than July 1, 2014.”

7. “If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use according to the timeline to avoid the payment adjustments. You may demonstrate meaningful use under either Medicare or Medicaid.”

8.  “EPs can apply for hardship exceptions to the payment adjustments.”

Jim Tate is founder of EMR Advocate and a nationally recognized expert on the CMS EHR Incentive Program, certified EHR technology and meaningful use.