Coding & Reimbursement

What EHR Promotion Means for You

By Suzanne L. Corcoran, COE

Congress wants to promote the use of electronic health records (or as it is more commonly referred to, electronic medical records) and has allocated funds for bonus payments to those physicians who move to EHR (or EMR, if you prefer). While we don't have all of the information yet, and guidelines have yet to be published, we do know the broad outlines.

Q. What financial incentive is there to implement EHR in the next few years?

A. The Health Information Technology for Economic and Clinical Health (HITECH) Act, a component of the American Recovery and Reinvestment Act signed into law in February 2009, contains two incentive programs for the adoption and use of EHR. One program is through Medicare and the other through Medicaid. Eligible professionals may only participate in one incentive program, not both.

The bonus is available to each provider who satisfies the eligibility criteria. So, in a group practice, each physician is eligible for a bonus.

Q. Who is eligible for a bonus?

A. The Medicare incentive program provides for physicians, as defined in the Social Security Act, who are office-based (including ophthalmologists). Hospital-based physicians do not qualify. Physician assistants and nurse practitioners do not qualify for the Medicare incentive but do qualify for the Medicaid incentive.

The Medicare program requires that the provider submit Part B claims of at least 133% of the maximum incentive for the program year. For example, if the maximum incentive for the year is $18,000, the provider must submit at least $24,000 in Part B charges. The Medicaid incentive is available to those that have at least 30% of their patient population receiving medical assistance. We expect that ophthalmologists will, for the most part, participate in the Medicare incentive program.

Both programs require the eligible professional to demonstrate "meaningful use" of a certified EHR program in their practices.

Q. What is "meaningful use"?

A. The Secretary of Health and Human Services is charged with finalizing the definition, but at this time the official definition is unknown. Most experts agree that it will likely include the following:

► Use of a certified technology that includes the ability to perform electronic prescribing.

► System capability to exchange information electronically.

► Ability to report on quality measures.

You can also expect additional requirements for security relating to Protected Health Information.

Q. If I qualify, how much is the bonus?

A. The table below describes the bonus structure for Medicare. The top row identifies the year the EMR system is implemented; the columns show the amount of the bonus payable each year. In addition, physicians practicing in a health professional shortage area may secure an additional 10%. Note that you must invest in a system before you are eligible for the bonus.

Q. Is there a penalty for not adopting EMR?

A. Yes, but not right away. Physicians who do not adopt a qualified EMR system by 2015 will see a 1% reduction in their Medicare payments. The reduction is 2% in 2016, and 3% in 2017 and beyond. In 2018, if the secretary of HHS determines that less than 75% of eligible professionals utilize EMR, additional reductions may occur.

Q. I already have an EMR system; may I receive the bonus now?

A. Existing systems, if they qualify, will be eligible for the bonus. However, until the final regulation is published, existing EMR users will not know if their current system qualifies for the program. In any case, incentive program dollars will not be distributed to any qualifying provider until 2011.

Q. May I participate in the E-Prescribing bonus program as well as this EMR incentive program?

A. No. Because the HITECH program contains a provision for E-Prescribing capability, the E-Prescribing bonus disappears for those receiving the HIT bonus. OM