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CMS-Based Quick Guide to Provider Incentives
Provided by MediSYS 2.24.10
Page references below are to the link below, select handouts:
http://www.cms.hhs.gov/NationalMedicareTrainingProgram/10_Audio_Conference_Training.asp
PQRI will continue through 2010. If it is extended beyond 2010, Eligible Professionals (EPs) can participate in both (EHR incentives) if eligible (pg 45)
How much? PQRI 2010: Possible incentive for EP's: 2% Medicare Allowed Charges
Tip: For Claims-based reporting, regularly review the Remittance Advice Notice you receive from the carrier to ensure the denial remark code N365 is listed for each QDC submitted.
2010 PQRI Made Simple: http://www.cms.hhs.gov/PQRI/downloads/2010PQRIMadeSimpleFS020310f_022210_FINAL.pdf
See what is new for PQRI 2010 at: http://www.cms.hhs.gov/PQRI/Downloads/WhatsNew2010PQRIFS020310f_022210_FINAL.pdf
ePrescribe Incentives to continue on a declining scale until 2013. Penalties begin 2012.
How much? ePrescribe 2010: Possible incentive for EPs: 2% of Medicare allowed charges. No sign-up / submit applicable G-code for 10% of Medicare allowed charge for 25 unique eRX events in 2010.
Tip: Regularly review the Remittance Advice Notice you receive from the carrier to ensure the correct denial remark code (for 2010: N365) is listed for each code submitted.
http://www.cms.hhs.gov/partnerships/downloads/11399-P.pdf
Note: if EP is participant in Medicare EHR incentives, they cannot participate in eRX incentive. If EP is participant in Medicaid EHR incentive they can participate in Medicare eRX. (pg 45) Also see Medicare's Practical Guide to ePrescribing Incentive Program
Medicare & Medicaid EHR Incentive
WHO:
Eligible Professionals (EP):
Medicare: Doctor of Medicine or Osteopathy, podiatric, optometry, chiropractor (pg 8)
Medicaid: 5 types of EPs -physicians, NP, CNMs, certain PAs (pg 10). Patient volume requirements and may not be an option in every state. Physicians with 30% Medicaid patient volume (20% for peds) (pg 12)
Selecting participation in one of two incentive programs with a one-time change available. CMS proposed EPs allowed to change their program selection only once during payment years 2012 - 2014
Hospital Based providers not eligible (i.e. 90% service in hospital setting)
WHAT:
Medicare: Meaningful Use EHR, Exchange of health information, Use EHR to submit measures:
- Core Quality measures (pg 26)
- Specialty Quality measures (pg 27)
Medicaid: Adopt, Implement & Upgrade EHR
WHEN:
March 15, 2010: Comment period for proposed rule ends. Post a Comment>> Select document type: Proposed Rule, Keyword: CMS-2009-0117-0002
CMS - goal for final rule publication Spring 2010. CMS is to issue additional guidance and review of State programs.
Implementation Time Line:
Medicare: Meaningful Use (pgs 15-19)
- 2011 - Medicare Stage 1 = Submit Measures / clinical data
- 25 Measures (8 are yes/no, 17 are numerator/denominator) 1st Year reporting period is 90 days, subsequent one year
- 2013 Stage 2 - Advanced Clinical Processes
- 2015 Stage 3 - Improved Outcomes
25 proposed Stage 1 Measures can be found on pgs 20-23.
Providers are required to submit summary quality measure data to CMS or states in 2011. In 2012 submit this summary electronically.
Medicaid: States may propose to CMS additional criteria
First Year Participation:
- Adopt - Acquire & Install
- Implement -Begin Utilization
- Upgrade - Expand Functionality ONC EHR Certification
Successive Participation Years: Meaningful Use
Payment Time Line:
Medicare: can pay incentives to EPs no sooner that Jan. 2011 (pg 40) Last year EP may initiate program 2014, last payment in program 2016, payment adjustments begin 2015. (pg 46)
Medicaid: EPs can potentially receive payment as early as 2010 (pg 40) Last year an EP may initiate program 2016, last payment in program 2021. (pg 46)
HOW MUCH: (pg 35-38)
Incentives:
Medicare: 2011-2016 Up to $44,000 over 5 years
Medicaid: Up to $63,750 over 6 years
Penalties:
Medicare: Up to 3% payment adjustment in Medicare reimbursement if not meaningful users.
See details from the most recent CMS Teleconference: Medicare & Medicaid EHR Incentive NPRM - click on handouts after following this link: http://www.cms.hhs.gov/NationalMedicareTrainingProgram/10_Audio_Conference_Training.asp
Disclaimer: This quick guide is a summary and is not intended as a comprehensive guide.