 |
What is the HITECH Act? |
| |
On February 17, 2009, President Barack Obama signed into law the American Recovery and Reinvestment Act (ARRA) of 2009. The $19.2 billion HITECH ACT, more commonly referred to as the Health Information Technology for Economic and Clinical Health Care Act, allocates $17.2 billion in Medicare and Medicaid incentives to eligible providers who adopt certified electronic health/medical records. |
| |
|
| |
|
|
How much are the incentive payments? |
| |
Medicare Incentives: Beginning in 2011 physicians who are “meaningful users” of “certified EMR/EHR technology” will be eligible to receive up to $44,000 paid out over a five-year period in the form of incentive payments through Medicare reimbursements. Medicare incentives are based on “meaningful use” and are not tied to the actual cost of acquiring or maintaining an EHR.
According to the Centers for Medicare and Medicaid Services (CMS), the incentive payment is equal to 75 percent of Medicare allowable charges for covered services furnished by the eligible provider in a year, subject to a maximum payment in years 1-5.
An additional 10% incentive bonus payment is available to physicians operating in a designated Health Professional Shortage Area (HPSA); for more information visit www.hpsafind.hrsa.gov.
The maximum payment for the first year is $18,000 (2011 and 2012) and bonus payments decline each subsequent year within the five-year period. Incentives will be paid out on a per provider basis. Bonus payments will phase out in 2016. See the table below for details. |
| |
|
| |
MEDICARE INCENTIVES BY YEAR SCHEDULE
| First Calendar Year for Incentive Payments |
| Calendar Year |
2011 |
2012 |
2013 |
2014 |
2015 |
2016 |
Total bonus payment |
| 2011 |
$18,000 |
$12,000 |
$8,000 |
$4,000 |
$2,000 |
$0 |
$44,000 |
| 2012 |
|
$18,000 |
$12,000 |
$8,000 |
$4,000 |
$2,000 |
$44,000 |
| 2013 |
|
|
$15,000 |
$12,000 |
$8,000 |
$4,000 |
$39,000 |
| 2014 |
|
|
|
$12,000 |
$8,000 |
$4,000 |
$24,000 |
| 2015 |
|
|
|
|
$0 |
$0 |
$0 |
| Source: Centers for Medicare and Medicaid Services. Because federal statutes, regulations and rulings change frequently, information in this table is subject to change. |
|
|
| |
|
| |
Medicaid Incentives: Non-hospital based physicians whose Medicaid patient caseload is at least 30% may be eligible for up to $63,500 in Medicaid incentive payments over a five-year period. Physicians must demonstrate “meaningful use” of a certified EMR/EHR product.
Note: Eligible providers must decide to receive either Medicare or Medicaid incentives, not both. However, hospitals will be eligible for both incentive payments. |
| |
|
| |
|
|
What are the proposed reporting periods? |
| |
The reporting period for 2011 requires you to submit for 90 consecutive days. Starting in 2012, the reporting period for each year is the entire calendar year. |
| |
|
| |
|
|
Why should you purchase and implement EMR/EHR now? |
| |
Although federal EHR incentive payments will not start until 2011, eligible providers who wait to implement EHR will face a high risk of failing to achieve meaningful use in time for the federal incentive payments. As an early adopter of EHR, it will be much easier for you to capitalize on incentive dollars-70% of the funding comes in the first two years. |
| |
|
| |
|
|
Are there penalties for not using EMR/EHR? |
| |
Starting January 1, 2015, physicians who are not “meaningful” EHR users will see a 1% reduction in Medicare payments. The reduction increases to 2% in 2016 and 3% in each subsequent year. If the United States Department of Health and Human Services (HHS) Secretary finds that by the end of 2017 the proportion of physicians who are meaningful EHR users is less than 75%, HHS may continue to ratchet down payments by 1% a year (not more than 5 percent overall). Hardship exceptions may be issued on a case-by-case basis, such as exceptions for physicians who practice in rural areas without adequate Internet access. |
| |
|
| |
|
|
How will maximEyes comply with certification standards? |
| |
First Insight guarantees to deliver certified EMR/EHR software that is compliant with federal government defined standards for meaningful use. Once HHS releases final certification standards and criteria, we will immediately submit maximEyes to be tested and certified in accordance with the ARRA certification program. Despite not having final certification criteria, First Insight’s government relations team and maximEyes user consultants have taken a proactive approach by reviewing the unofficial criteria to get a head start—making sure we are prepared well in advance.
On March 2, 2010, HHS released a proposed “two-phased approach” for establishing a certification program to test and certify EHR technology (see http://healthit.hhs.gov). Under the temporary certification process, the ONC National Coordinator would authorize organizations to test and certify EHR technology. The permanent certification program would transition much of the responsibility to organizations in the private sector. While some EHR companies are announcing they are ARRA certified through CCHIT, this is not a guarantee that their system will comply—final criteria and standards have not been finalized by the federal government. |
| |
|
| |
|
|
What is a meaningful user? |
| |
On January 13, 2010, the Department of Health and Human Services (HHS) published “Interim Final Rules” in the Federal Register that describe how eligible providers must demonstrate meaningful use to qualify for government incentive payments. Final rules are expected to be released by late spring 2010.
HHS has proposed a “three-stage effort” for the incentive payment program: Stage 1 (2011-2012), Stage 2 (2013-2014) and Stage 3 (2015). For Stage 1, HHS has proposed 25 objective/measures associated with meeting meaningful use. However, eligible providers must also meet the following elements to qualify for incentive payments:
• Use certified EHR software, which must include the ability to send compliant electronic prescriptions to pharmacies.
• Electronically exchange (interoperability) patient health information with labs, hospitals, providers, payers and other EHR.
• Submit compliant clinical quality measures, such as PQRI. |
| |
|
| |
|
|
Are First Insight software products CCHIT certified? |
| |
First Insight is a member of the CCHIT Eye Care Work Group, which includes members from professional organizations, such as AAO, ASCRS and AOA. Currently, CCHIT testing criteria is not yet available for eye care specialty EMR/EHR software. However, the CCHIT Certification Commission has committed to providing eye care specialty testing criteria for optometry and ophthalmology before 2011. This timeline may change to an earlier date due to the emerging requirements of the American Recovery and Reinvestment Act EHR Stimulus Bill. Once CCHIT releases eye care specialty criteria, First Insight will begin the process of ensuring that our software products are CCHIT certified. |
| |
|
| |
|
|
What incentives are available now for PQRI data verification? |
| |
Eligible providers who successfully report PQRI quality information in 2010 may earn a bonus payment of 2 percent of their total allowed charges for Medicare Part B covered professional services. Allowable charges are that portion of the submitted charges that is approved for Medicare payment (including the deductible and coinsurance).
Eligible providers must report a minimum of three quality measures at least 80% of the time on claims submitted during the PQRI 2010 reporting period. There are two reporting options in 2010: January 1 through December 31, 2010, or July 1 through December 31, 2010.
Did you know that maximEyes will prompt you when a patient qualifies for PQRI then will automatically add the codes to the Superbill? MaximEyes also checks to see if the patient has Medicare, verifies the patient’s age at the time of exam, reviews diagnoses and procedure codes, and reviews specific items detailed under the PQRI measures. |
| |
|
| |
|
|
What incentives are available now for ePrescribing? |
| |
In 2010, physicians who successfully ePrescribe may receive a bonus payment of 2 percent of their overall Medicare Part-B professional services. Amounts will vary depending on the annual allowable Medicare Part-B billings. In 2011-2012, the reward for ePrescribing will be 1 percent, while the penalty for not ePrescribing begins in 2012.
CMS has made changes in 2010 by only requiring eligible providers to enter one G-code to show a visit resulted in an electronic prescription. Simply add G-code G8553 to your Superbill to show the visit resulted in you sending an e-prescription using a qualified electronic prescribing system. Next, bill the G-code for at least 25 unique ambulatory visits during the calendar year. It’s important that you do not enter 2009 G-codes or this will result in the loss of eligibility for the incentives.
Did you know that First Insight was the first company focused exclusively on the ophthalmic market to publicly launch a true “end-to-end” ePrescribing solution through our integration with DrFirst's® award winning GoldRxTM certified RcopiaTM ePrescribing technology. Learn more about maximEyes’ built-in e-prescribing link. |
| |
|
| |
|
|
How can you get started and reap the benefits? |
| |
Contact First Insight at sales@first-insight.com and send us your comments or questions. Or complete an online form to schedule a personalized demo and we’ll be happy to help you develop a plan of action, evaluate a return on your investment, and create a smooth-running paperless office using maximEyes software. |
| |
|
| |
|
|
Resources, Articles and Quick Links |
| |
 |
HIMSS: News about Meaningful Use, Certification Criteria, Criteria and Standards, FAQs, and Health and Human Services Certification Process |
|
Health and Human Services: Download "interim rules and regulations" and submit "public comments" |
|
HITECH Answers: An Independent Analysis of the Healthcare Stimulus Package and HITECH Act |
|
EHRWatch.com: News, commentary and developments in EHR |
|
IHealthBeat.com: News and reports on technology’s impact on health care |
|
FierceEMR.com: News and insights about EHR adoption, implementation, incentives, security and more |
|
| |
|
| |
Note: First Insight has made every effort to provide you with the most recent information. Because federal statutes, regulations and rulings change frequently, information is this article is subject to change. This is provided to you for informational purposes only. We recommend that you seek professional advice from your attorney, accountant or other professional advisor. |
| |
|
| |
|
