Transcript CMS Update - Rural health

CMS Update
Rural Health Association of
Oklahoma
September 23, 2010
What’s New?
• Dr. Donald Berwick named as CMS
Administrator on July 7, 2010
Former President and CEO of the Institute for
Healthcare Improvement
Clinical Professor of Pediatrics and Health Care
Policy at Harvard Medical School
RHC Regulation – Soon?
• Balanced Budget Act of 1997 enacted
• February 2000 – First Proposed Rule
• December 2003 – Final Rule issued, but
suspended due to new statutory requirement
(MMA of 2003) that no more than 3 years can
elapse between a proposed and final rule
• June 2008 – New Proposed Rule issued
• MMA 2003 requires Final Reg to be published
within 3 years of Proposed Rule = June 2011
Patient Protection and Affordable
Care Act (PPACA) Enacted 3/23/10
• Preventive Services Changes Beginning
1/1/2011:
Coverage of Annual Wellness Visit Providing a
Personalized Prevention Plan (initial and
subsequent visits)
• Elimination of Beneficiary Cost-Sharing for
Preventive Services for Annual Wellness Visit,
Initial Preventive Physical Exam (IPPE), and
other Medicare preventive services
recommended by USPSTF with a grade of A or B
Coinsurance and Deductible Waived
Beginning in 2011
• Annual Wellness Exam, IPPE, Abdominal Aortic
Aneurysm Ultrasound Screening, screening lab
tests for diabetes and cardiovascular disease,
PAP test, screening pelvic exam, screening
mammography, bone mass measurement, PSA
test, colorectal cancer screenings (except
barium enema), HIV screening lab tests,
vaccine and administration for flu,
pneumococcal and hepatitis B, medical
nutrition therapy
Preventive Cost Sharing Still Applies
• Diabetes Self-Management Training (DSMT) –
coinsurance and deductible apply
• Barium Enema as colorectal cancer screening
– coinsurance applies, deductible is waived
• Digital rectal exam as prostate cancer
screening – coinsurance and deductible apply
• Glaucoma screening for high risk patients –
coinsurance and deductible apply
PPACA Primary Care Incentive
• 1/1/11 - 10% bonus for primary care
physicians, NPs, CNSs, PAs for whom primary
care services = at least 60% of allowed Part B
charges in a prior period (first time will use CY
2009 PFS claims data processed through
6/30/10), paid quarterly for primary care
services furnished during that quarter
Paid in addition to usual 10% HPSA bonus
PPACA Surgical Incentive
• 1/1/11: 10% bonus to general surgeons when
furnishing a major surgery (10 or 90 day
global) in a geographic HPSA, paid quarterly
• Paid in addition to usual HPSA bonus payment
Patient Protection and Affordable
Care Act (PPACA)
• Changes timely filing deadline to one year, beginning
with services provided on or after 1/1/10,
Services provided from 10/1/09 to 12/31/09 must be
filed by 12/31/10.
At this point, there are no exceptions to the new
requirement.
• Watch Medicare contractor listserv for earliest news
on other changes as they become known
2011 Physician Fee Schedule
Regulation – Proposed 7/13/10
• Propose to add to telehealth benefit:
• Individual and group kidney disease education
services (G0420-1)
• Individual and group DSMT services (G0108-9)
• Group MNT and Health and Behavior
Intervention services (97804, 96153-4)
• Subsequent hospital care services (99231-3)
• Subsequent SNF/NF services (99307-10)
2011 PFS Proposed Rule
• Affordable Care Act (PPACA) requires PPS
system be developed for FQHCs by 2014
• PFS proposes to begin collecting data to
develop new PPS on 1/1/2011
• 1/1/2011 FQHCs will be required to file claims
using HCPCS codes (not currently required)
2011 PFS Proposed Rule
• ACA reinstates physician work geographic
floor, protection of frontier states, payment of
technical component of physician pathology
services, ambulance add-on, reasonable cost
for lab in rural hospitals <50 beds
• ACA changes payment for certified nurse
midwife services to the same as physicians on
Medicare fee schedule (80% of allowable
charge)
Inpatient Prospective Payment
System Final Rule Effective
10/1/2010
• Acute care transfer policy will now apply to
patients discharged to critical access hospitals
and non-participating hospitals (not VA or
DoD)
• Payment adjustments for low volume
hospitals in 2011-12 if hospital is more than
15 mi. from another subsection (d) hospital
and has fewer than 1,600 discharges for
patients entitled to Part A in the fiscal year
IPPS Final Rule
• Medicare Dependent Hospital – extended
through FY 2012 (ending 10/1/12) and will
count all days/discharges of patients entitled
to Medicare Part A beginning 10/1/10
• CRNA Services furnished in rural hospitals and
CAHs – for cost reporting periods beginning on
or after 10/1/10, CAHs and hospitals
reclassified according to 1886(d)(8)(E) and
Sec. 412.103 are also rural and can be paid
reasonable cost for CRNA services (Lugar N/A)
IPPS Final Rule
• $400 million in Payments for Qualifying
Hospitals with Lowest Per Enrollee Medicare
Spending – subsection (d) hospital located in
an eligible county, paid in FY 2011 and FY 2012
• Rural Community Hospital Demo extended to
20 states with low population density and to
20 more hospitals
IPPS Final Rule
• PPACA changes 3-day payment window
implementation for non-CAH hospitals –
hospitals must include on inpatient bill the
diagnoses, procedures, and charges for all
outpatient preadmission diagnostic services
and all outpatient preadmission nondiagnostic
services (except ambulance and maintenance
renal dialysis) provided by the subsection (d)
hospital or entity that is wholly owned or
operated by the hospital
IPPS Final Rule
• Services on date of admission are deemed
related and also services provided on the first,
second and third calendar day prior to the
admission are also deemed related to the
admission unless the hospital attests that the
services are not related to the admission
• A “Related” outpatient service is one that is
clinically associated with the reason for a
patient’s inpatient admission
IPPS Final Rule
• CAHs electing Method 2 no longer required to
make annual re-election, unless wish to
terminate election 30 days before cost report
period end
• If CAH CR period begins in October 2010 or
November 2010 and elected Method 2 in
2009 and wish to terminate Method 2, you
have until 12/1/2010 to do so
IPPS Final Rule
• PPACA made conforming change for CAHs to
make 101% of reasonable cost for Method 2
and to make 101% of reasonable cost for CAHbased ambulances, retro to 1/1/2004, but no
reprocessing since contractors paid the claims
this way anyway
• CAHs can claim provider taxes as allowable
costs only to the extent the assessed taxes are
actually incurred
Outpatient Prospective Payment
System Proposed Rule 8/3/10
• Hold Harmless Transitional Payments expires
on 1/1/2011
• Physician Supervision Policy for Outpatient
diagnostic services: hospitals (but not CAHs)
must follow MPFS physician supervision
requirements for individual tests (general,
personal, or direct) for services provided
directly or under arrangement for services
provided onsite in hospital, provider-based
department or nonhospital location
OPPS Proposed Rule
• For outpatient therapeutic services in
hospitals and CAHs, proposing changes and
requesting comments: for a limited set of
services with a significant monitoring
component that are not surgical and typically
have a low risk of complication, would require
direct physician supervision for the initiation
of the service followed by general supervision
for the remainder of the service (list does not
include chemo and blood transfusions)
OPPS Proposed Rule
• Proposing to revise the MPFS to apply a
multiple procedure reduction to payment for
all outpatient physical and occupational
therapy services
• Proposing changes to whole hospital and rural
provider exceptions to the physician selfreferral prohibition
Ordering/Referring Update
• CMS is delaying implementation of CR 6417 and
CR 6421 until January 3, 2011 to give all
physicians and practitioners time to update their
enrollment information in PECOS. Applies to
physicians, PA, NP, CNM, CNS, CP and CSW.
Once implemented, Part B CMS 1500 claims for
services that were ordered/referred will need to
include ordering/referring NPI information. If the
ordering/referring physician is not in PECOS, the
claim will be rejected and later denied.
Regulation Implementing PPACA
• 5/5/10 Interim Final Regulation implements
provision of law to permit only a Medicare
enrolled physician/eligible professional to certify
or order home health, DMEPOS supplies and
other Part B services, and applies to orders,
referrals and certifications on and after 7/1/10,
comment period closes 7/6/10.
• CMS will not implement automatic rejection of
claims for services ordered by providers whose
PECOS applications have not been approved by
7/6/10 – (CMS Press Release 6/30/10)
Ordering/Referring PECOS File
• www.cms.hhs.gov/MedicareProviderSupEnroll
• Over 800,000 names and NPIs on file in PECOS
of physicians and non-physician practitioners
eligible to order/refer
• Sorted in alpha order by last name, with NPI
Ordering/Referring for
RHC/FQHC/CAH Physicians
• Physicians/NPPs who would not be sending
claims to Medicare Part B can still enroll for the
sole purpose of ordering or referring
• Paper form CMS-855I, complete only certain
sections, and attach a cover letter stating
provider is only enrolling to order and refer
services for a beneficiary and cannot be
reimbursed for services performed
• Mail application to designated Part B MAC
provider enrollment address (see TrailBlazer
website www.trailblazerhealth.com for details)
Internet-Based PECOS Enrollment
• Available to Part B individuals, groups,
organizations and Part A providers
• https://pecos.cms.hhs.gov
• RHCs, FQHCs not allowed to use the Internetbased PECOS
• All providers use paper 855 for filing changes of
ownership, acquisition, mergers, consolidations,
changes in tax ID, changes in legal business name
Rejection of Enrollment Application
• CMS contractors may reject a provider’s or
supplier’s enrollment application if they fail to
furnish complete information on the application
within 30 calendar days from the date of the
contractor’s request for the missing information
• After rejection, a provider or supplier must
complete and submit a new enrollment
application and documentation for review and
approval
Recent Enrollment Changes
• Establishes an effective date of billing for
physicians, non-physician practitioners and
physician and NPP organizations as the later
of
1) the filing of an enrollment application that
is subsequently approved or
2) the date an enrolled physician or NPP first
started furnishing services at a new practice
location
Recent Enrollment Changes
• Permits physicians and non-physician
practitioners to retrospectively bill for services
rendered up to 30 days prior to the effective
date, if they met all program requirements or
services rendered up to
90 days prior when there is a Presidentiallydeclared disaster
• No longer unlimited retroactive billing
Recent Enrollment Changes
• Requires all providers and suppliers, including
individual practitioners, to maintain ordering
and referring documentation for 7 years from
the date of service
Enrollment Reportable Events –
30 Day Timeframe
• All providers/suppliers must report a change
in ownership or control on CMS 855 form
within 30 days
• Physicians and non-physician practitioners are
required to report the following changes on
CMS 855 form within 30 days of these events:
• 1. Change of ownership
• 2. Change in practice location
• 3. Final adverse action
Penalties for Not Meeting 30-Day
Reportable Events
• Failure to notify the Medicare contractor of
these changes may result in a revocation
(termination of billing privileges) and/or
overpayment from the date of the reportable
change
• Providers/suppliers whose billing privileges
are revoked may be barred from re-enrolling
in Medicare for 1-3 years
Enrollment Reportable Events – 90 Day
Timeframe
• Physician and non-physician practitioners are
required to report on CMS 855 form the following
changes no later than 90 days after the event:
• 1) Change in practice status (e.g., retirement)
• 2) Change of business structure, legal business name
or taxpayer ID Number
• 3) Change of banking arrangements or payment
information
• 4) A change in the correspondence or special
payments address
Enrollment Reportable Events – 90
Day Timeframe
• All providers/suppliers must report on CMS
855 form within 90 calendar days of the
following changes:
•
•
•
•
Change in practice location
Change of any managing employee
Change in billing services
Other changes
Penalties for Not Meeting 90-Day
Reportable Events
• Medicare contractors may deactivate a
provider or supplier’s Medicare billing
privileges for failure to report changes within
90 days of the event, and providers/suppliers
must complete and submit a new enrollment
application to reactivate Medicare billing
privileges
Periodic Revalidation of Medicare
Enrollment Information
• Providers/suppliers (other than DMEPOS and
ambulance) must resubmit and recertify the
accuracy of its enrollment information every 5
years
• CMS Medicare contractors will contact providers
and suppliers directly when it is time to revalidate
their information
• Providers/suppliers must submit complete
application and documentation within 60
calendar days of the notification
Penalty for Failure to Respond to
Revalidation Request
• Providers who fail to respond to the CMS
Medicare contractor’s revalidation request
may have billing privileges revoked and may
be barred from re-enrolling in Medicare for
one year
More Information on Medicare
Enrollment
• Go to CMS website
www.cms.gov/MedicareProviderSupEnroll
• CMS Internet Only Manual 100-08, Chapter 10
• Federal Regulations 42 CFR 424.500
A/B MAC Implementation
• MMA 2003 requires geographic assignment of providers
• All new Part A or Part B providers enroll with the Medicare
Administrative Contractor (MAC) serving their state, or with the
legacy contractor serving the state if there is no MAC yet
•
New freestanding RHCs and FQHCs (including FQHC satellites) are
no longer assigned to regional or national FIs (only HHA/hospice
and DMEPOS are still assigned to regional MACs)
• New Freestanding RHCs now enroll with the MAC for their state, or
if the MAC has not been awarded yet, it will enroll with the local
Medicare fiscal intermediary in their state
• New Provider-Based RHCs and other provider-based entities
continue to enroll with the FI/MAC that serves the parent provider
A/B MAC Implementation
• Existing Out-of-jurisdiction providers (e.g., those
with Mutual/WPS, and providers with former
regional or national FIs that are not the MACs for
the state where they are located) will not
transition to the MAC for their state until after all
the MAC contracts are fully implemented
• WPS/Mutual providers in J4 jurisdiction are in
the process of being transitioned to J4 by October
18, 2010
Medicare Advantage Payment Guide
• CMS guidance to MA plans regarding original
Medicare payments to providers (for PFFS
plan payments and out-of-network provider
payments):
http://www.cms.hhs.gov/MedicareAdvtg
SpecRateStats/downloads/oon-payments.pdf
Be Prepared – New X12 Standards
• HIPAA Version 5010 Level I Compliance by
12/31/10 (covered entities demonstrate they
can create and receive compliant transactions)
and Level II Compliance by 1/1/12 (covered
entities complete testing with all trading
partners and are able to operate in production
mode with new version of the standards)
• http://www.cms.hhs.gov/Versions5010
andD0 (note the last is a zero)
Be Prepared – ICD-10
• 1/16/09 HIPAA Final Rule to adopt ICD-10-CM
and ICD-10-PCS by October 1, 2013 for all
covered entities
• http://www.cms.hhs.gov/ICD10 for info on
educational resources, code tables and
descriptions, mappings, etc.
PS&R Reports via Internet
• Must establish an IACS account and be approved
for PS&R access
• IACS verification process includes the submission
of supporting documentation and may take
several weeks to complete the entire process, so
start in advance of when you need it for cost
report preparation
• CMS PS&R Redesign Web page has user manuals,
guides, etc. (link on TrailBlazer website, and CMS
website CR 6519)
CMS/HHS Rural Resources
• CMS Open Door Forum Calls:
http://www.cms.hhs.gov/OpenDoorForums for
information on signing up for Rural Open Door
listserv
• CMS Web site Rural Health Clinic Center
http://www.cms.hhs.gov/center/rural.asp
• HRSA Office of Rural Health Policy Rural Assistance
Center – one-stop shopping for all Department of
HHS rural info
http://raconline.org
CMS Rural Resources
• Medicare Learning Network:
http://www.cms.hhs.gov/MLNGenInfo
• Medlearn Matters Listserv:
https://list.nih.gov
• Sign up for your Medicare contractor’s listserv:
http://www.cms.hhs.gov/MLNProducts/
downloads/CallCenterTollNumDirectory.zip to
get web address of your contractor’s homepage
Medicare & Medicaid EHR
Incentive Program
A Short History of MU
• American Recovery & Reinvestment Act
(Recovery Act) – February 2009
• Medicare & Medicaid Electronic Health
Record (EHR) Incentive Program Notice of
Proposed Rulemaking (NPRM)
• Publication – January 13, 2010
• NPRM Comment Period Closed – March 15, 2010
• CMS received 2,000+ comments
• Final Rule on Display – July 13, 2010
• Final Rule Published – July 28, 2010
Three-Legged Stool
Meaningful Use
• Final Rule released by CMS in July, 2010
Standards
• Final Rule released by ONC in July, 2010
Certification
• Temporary Program Final Rule released by ONC in June,
2010
Standards and Certification
• Standards & Certification IFR
– Establishes the required capabilities and related
standards that certified EHR technology will need to
include in order to, at a minimum, support the
achievement of proposed Stage 1 Meaningful Use
• Certification Program NPRM
– Provides assurance to purchasers and other users that
HIT offers the necessary technological capability,
functionality, and security to help them meet the
Meaningful Use criteria established for a given phase
EHR Incentive Program
• The EHR Incentive Programs provide incentive
payments to eligible professionals, eligible
hospitals, and critical access hospitals (CAHs)
for adopting and meaningfully using certified
EHR technology
• EHR Incentive Programs
– Medicare
– Medicare Advantage
– Medicaid
Meaningful Use: Process of
Defining
• National Committee on Vital and Health
Statistics (NCVHS) hearings
• HIT Policy Committee (HITPC)
recommendations
• Listening Sessions with providers/organizations
• Public comments on HITPC recommendations
• Comments received from the Department and
the Office of Management and Budget (OMB)
• Revised based on public comments on the
NPRM
Office of the National Coordinator for
Health IT (ONC)
• Resource for the entire U.S. health system
• Supports and coordinates efforts to
improve health care through:
– Adoption of health information technology (HIT)
– Nationwide health information exchange (HIE)
• Created in 2004, then mandated in 2009 in
the Health Information Technology for
Economic and Clinical Health (HITECH) Act
How HITECH Addresses Barriers to Adoption
Obstacle
Market Failure, Need for
Financial Resources
Intervention
Lead Agency
•
Medicare and Medicaid EHR
Incentive Programs for “Meaningful
Use”
•
CMS
Addressing Adoption
Difficulties
•
•
Regional Extension Centers
Health IT Research/Resource Center
•
ONC
Workforce Training
•
Workforce Training Programs
•
ONC
•
•
ONC
•
Strategic Health Information
Technology Advanced Research
Projects
Beacon Communities Programs
•
•
Policy Framework
New Privacy and Security Policies
•
•
NHIN, Standards and Certification
State Cooperative Agreement
Program (HIE)
Addressing Technology
Challenges and Providing
Breakthrough Examples
Privacy and Security
Need for Platform for Health
Information Exchange
•
•
OCR
ONC
Regional Extension Centers (RECs)
• Goal: Assist at least 100,000 primary care providers in
achieving Meaningful Use by 2012
• Funded through 4-year Cooperative Agreements
• 60 RECs, covering 98% of the USA
• RECs Support Primary Providers in these priority settings:
– Individual and small group practices focused on primary
care (10 or fewer care providers)
– Public and Critical Access Hospitals
– Community Health Centers and Rural Health Clinics
– Other settings (medically underserved populations)
State Health Information Exchange
• Goal: Give every provider options for meeting health
information exchange (HIE) Meaningful Use requirements
• 4-year program to support state programs to ensure the
development of HIE within and across their jurisdictions
• 56 states and territories awarded funding for HIE planning
and implementation
• States need an ONC-approved State Plan before federal
funding can be used for implementation
• Exchange must meet national standards
Workforce Training Programs
• Goal: Help train up to 50,000 new HIT workers to assist
providers in becoming Meaningful Users of EHRs
• Four distinct programs that aim to support the education
of new HIT professionals, including:
–
–
–
–
Community college consortia
Curriculum development centers
University-based training
Competency examination program
The Beacon Community Program
• Goal: Share best practices that help communities
achieve cost savings and health improvement
• 15 demonstration communities* that will:
– Build and strengthen their HIT infrastructure and
exchange capabilities and showcase the Meaningful
Use of EHRs
– Provide valuable lessons to guide other communities
to achieve measurable improvement in the quality
and efficiency of health services or public health
outcomes
*Two additional communities to be funded in Summer 2010
Eligibility Overview
• Medicare Fee-For-Service (FFS)
• Eligible Professionals (EPs)
• Eligible hospitals and critical access hospitals
(CAHs)
• Medicare Advantage (MA)
• MA EPs
• MA-affiliated eligible hospitals
• Medicaid
• EPs
• Eligible hospitals
Who is a Medicare Eligible
Provider?
Eligible Providers in Medicare FFS
Eligible Professionals (EPs)
Doctor of Medicine or Osteopathy
Doctor of Dental Surgery or Dental Medicine
Doctor of Podiatric Medicine
Doctor of Optometry
Chiropractor
Eligible Hospitals
Acute Care Hospitals*
Critical Access Hospitals (CAHs)
*Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or Washington, DC (including
Maryland)
Who is a Medicaid Eligible
Provider?
Eligible Providers in Medicaid
Eligible Professionals (EPs)
Physicians
Nurse Practitioners (NPs)
Certified Nurse-Midwives (CNMs)
Dentists
Physician Assistants (PAs) working in a Federally Qualified Health Center
(FQHC) or rural health clinic (RHC) that is so led by a PA
Eligible Hospitals
Acute Care Hospitals (now including CAHs)
Children’s Hospitals
Hospital-based EPs
• Hospital-based EPs do not qualify for Medicare
or Medicaid EHR incentive payments.
• The Continuing Extension Act of 2010 modified
the definition of a hospital-based EP as
performing substantially all of their services in
an inpatient hospital setting or emergency
room. The rule has been updated to reflect this
change.
• A hospital-based EP furnishes 90% or more of
their services in either the inpatient or
emergency department of a hospital.
Medicaid Only: Adopt/Implement/
Upgrade (A/I/U)
• First participation year only for Medicaid providers
• Adopted – Acquired and Installed
• Ex: Evidence of installation prior to incentive
• Implemented – Commenced Utilization of
• Ex: Staff training, data entry of patient demographic
information into EHR
• Upgraded – Expanded
• Upgraded to certified EHR technology or added new
functionality to meet the definition of certified EHR
technology
• Must use certified EHR technology
• No EHR reporting period
Meaningful Use: HITECH Act
Description
• The Recovery Act specifies the following 3
components of Meaningful Use:
1. Use of certified EHR in a meaningful manner
(e.g., e-prescribing)
2. Use of certified EHR technology for electronic
exchange of health information to improve
quality of health care
3. Use of certified EHR technology to submit
clinical quality measures (CQM) and other
such measures selected by the Secretary
Conceptual Approach to
Meaningful Use
Data
capture
and sharing
Advanced
clinical
processes
Improved
outcomes
Meaningful Use Stage 1 –
Health Outcome Priorities*
• Improve quality, safety, efficiency, and
reduce health disparities
• Engage patients and families in their health
care
• Improve care coordination
• Improve population and public health
• Ensure adequate privacy and security
protections for personal health information
•
*Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s
Healthcare. Washington, DC: National Quality Forum; 2008.
Meaningful Use: Basic Overview
of Final Rule
• Stage 1 (2011 and 2012)
• To meet certain objectives/measures, 80%
of patients must have records in the
certified EHR technology
• EPs have to report on 20 of 25 MU
objectives
• Eligible hospitals have to report on 19 of 24
MU objectives
• Reporting Period – 90 days for first year;
one year subsequently
Next Steps
• Summer/Fall 2010 – Outreach and education
campaign
• CMS to issue State Medicaid Directors Letter
with policy guidance on the implementation of
the Medicaid EHR Incentive Program
• Early 2011 – EPs and eligible hospitals can
register for the Medicare and Medicaid EHR
Incentive Programs
• More Information:
http://www.cms.gov/EHRIncentivePrograms
For More Information
Visit the ONC Web site: healthit.hhs.gov
Current RECs
United States Regional Extension Centers
*Note: applicable regions across the nation may also be supported by the Indian Health Board Regional Extension Center, headquartered in Washington DC.
Registration Overview
• All providers must:
• Register via the EHR Incentive Program website
• Be enrolled in Medicare FFS, MA, or Medicaid
(FFS or managed care)
• Have a National Provider Identifier (NPI)
• Use certified EHR technology to demonstrate
Meaningful Use
• Medicaid providers may adopt, implement, or upgrade in
their first year
• All Medicare providers and Medicaid eligible
hospitals must be enrolled in PECOS
Registration: Medicaid
• States will connect to the EHR Incentive
Program website to verify provider
eligibility and prevent duplicate payments
• States will ask providers for additional
information in order to make accurate and
timely payments
•
•
•
•
Patient Volume
Licensure
A/I/U or Meaningful Use
Certified EHR Technology
Registration: Requirements
1. Name of the EP, eligible hospital, or qualifying
CAH
2. National Provider Identifier (NPI)
3. Business address and business phone
4. Taxpayer Identification Number (TIN) to which the
provider would like their incentive payment made
5. CMS Certification Number (CCN) for eligible
hospitals
6. Medicare or Medicaid program selection (may
only switch once after receiving an incentive
payment before 2015) for EPs
7. State selection for Medicaid providers
Incentive Payments for Medicare
EPs
• First Calendar Year (CY) for which the EP Receives an
Incentive Payment
CY 2011
CY 2012
CY 2013
CY2014
CY 2015
and later
CY 2011
$18,000
CY 2012
$12,000
$18,000
CY 2013
$8,000
$12,000
$15,000
CY 2014
$4,000
$8,000
$12,000
$12,000
CY 2015
$2,000
$4,000
$8,000
$8,000
$0
$2,000
$4,000
$4,000
$0
$44,000
$39,000
$24,000
$0
CY 2016
TOTAL
$44,000
Additional Incentive Payments for
Medicare EPs Practicing in HPSAs
• First Calendar Year (CY) for which the EP Receives an
Incentive Payment
CY 2011
CY 2012
CY 2013
CY2014
CY 2015
and later
CY 2011
$1,800
CY 2012
$1,200
$1,800
CY 2013
$800
$1,200
$1,500
CY 2014
$400
$800
$1,200
$1,200
CY 2015
$200
$400
$800
$800
$0
$200
$400
$400
$0
$4,400
$3,900
$2,400
$0
CY 2016
TOTAL
$4,400
Incentive Payments for Medicaid EP
• First Calendar Year (CY) for which the EP Receives an Incentive
Payment
CY 2011
CY 2012
CY 2013
CY 2014
CY 2015
CY 2016
CY 2011
$21,250
CY 2012
$8,500
$21,250
CY 2013
$8,500
$8,500
$21,250
CY 2014
$8,500
$8,500
$8,500
$21,250
CY 2015
$8,500
$8,500
$8,500
$8,500
$21,250
CY 2016
$8,500
$8,500
$8,500
$8,500
$8,500
$21,250
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
CY 2017
CY 2018
CY 2019
CY 2020
CY 2021
TOTAL
20-Jul-10
$8,500
$63,750
$63,750
$63,750
$63,750
$63,750
$63,750
77
EHR Incentive Program Timeline
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January 2011 – Registration for the EHR Incentive Programs begins
January 2011 – For Medicaid providers, States may launch their programs if
they so choose
April 2011 – Attestation for the Medicare EHR Incentive Program begins
May 2011 – EHR incentive payments begin
November 30, 2011 – Last day for eligible hospitals and CAHs to register and
attest to receive an incentive payment for FFY 2011
February 29, 2012 – Last day for EPs to register and attest to receive an
incentive payment for CY 2011
2015 – Medicare payment adjustments begin for EPs and eligible hospitals
that are not meaningful users of EHR technology
2016 – Last year to receive a Medicare EHR incentive payment; Last year to
initiate participation in Medicaid EHR Incentive Program
2021 – Last year to receive Medicaid EHR incentive payment
EHR Incentive Resources
• OFMQHIT Oklahoma REC – Daniel T. Golder,
DDS, MBA (405) 302-3318
• Oklahoma Health Care Authority – John
Calabro, CIO www.okhie.org/default.aspx
• Dallas CMS HITECH Team Lead – Kathy Maris
(214) 767 -4446 [email protected]
QUESTIONS?
• Thank you for all you do to serve Medicare
and Medicaid beneficiaries in rural areas!
Becky Peal-Sconce
CMS Regional Rural Health Coordinator
Dallas, Texas
(214) 767-6444
[email protected]