Tag Archives: Healthcare IT

Eligibility for ARRA Stimulus Money

The American Recovery & Reinvestment Act (ARRA) provides $20 billion in incentives to eligible professionals to implement certified EMR technology.  However, to qualify for the incentive package a provider must first be eligible to participate in the program and then has to demonstrate “meaningful use” of the certified EMR technology.

To qualify, you must first be eligible to participate in the program.   There are two programs to choose from, Medicare and Medicaid, and they have slightly different requirements.

To be eligible for Medicare program, you must be a:

  • Doctor of medicine or osteopathy
  • Doctor of dental surgery or dental medicine
  • Doctor of podiatry
  • Doctor of optometry
  • Chiropractor

To be eligible for Medicaid program, you must be a:

  • Physicians (primarily doctors of medicine and doctors of osteopathy)
  • Nurse practitioner
  • Certified nurse-midwife
  • Dentist
  • Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.

There are additional requirements to be eligible.  CMS provides a flowchart which you can use to determine your eligibility.  If you qualify for both programs, CMS suggests that you should apply for the Medicaid program.

If you are eligible for and select the Medicare program, you can qualify for up to $44,000 of the incentive money.  The incentive is paid over five (5) years.  The incentive will provide you with maximum amount if you start the qualification early, which means in 2011 or 2012; if you wait till 2013 to qualify, you will lose $5000 of the $44,000 and if you wait to qualify in 2014 you will lose $20,000.  There is no incentive money if you qualify in 2015 or thereafter.

There is additional incentive if you predominantly provide services in areas designated as Health Professional Shortage area – your amount of the annual EMR incentive payment limit for each payment year will be increased by 10%.

If you are eligible for and select the Medicaid program, you can qualify for up to $63,750 per doctor. You must adopt, implement, upgrade or demonstrate meaningful use of certified EMR technology in the first year of participation and then demonstrate meaningful use in years 2-6 of participation. For calendar years 2011-2021, you can receive up to $63,750 over 6 years. Incentive payments will be made by the State based on the calendar year.

It is important to note that beginning in 2015 Medicare eligible professionals who do not successfully demonstrate meaningful use will have a payment reduction in their reimbursement. The payment reduction will start at 1% and increase up to 5% for every year that you do not demonstrate meaningful use.

Hospital-based physicians and Medicaid eligible professionals will not be subject to payment reduction. However, if you are also a Medicare Fee-for Service provider and cannot successfully demonstrate meaningful use, you will be subject to payment reduction in your Medicare reimbursement, even if you never received an incentive payment or only participate in the Medicaid incentive program.

The incentive payments are provided based on individual practitioners. In a medical practice, each individual eligible professional may qualify for an incentive payment if they successfully demonstrate meaningful use of certified EMR technology. However, an individual may only qualify under one practice only, regardless of how many locations they provide the service.

Eligible professionals providing 90% or more of their services in a hospital inpatient (Place Of Service code 21) or emergency room (Place Of Service code 23) setting are not eligible for incentive payments.

Registration for Medicare and Medicaid incentive program begin on January 3, 2011; more information can be found at the CMS Registration and Attestation web page.

Register at NetFunction website to learn how we can help you with your EMR and HIPAA/HITECH compliance.

© NetFunction Inc. and Adventures in HIT and BIT, 2010.

For 2015 and later, Medicare eligible professionals who do not successfully demonstrate meaningful use will have a payment reduction in their Medicare reimbursement. The payment reduction starts at 1% and increases up to 5% for every year that a Medicare eligible professional does not demonstrate meaningful use. Hospital-based physicians and Medicaid eligible professionals are not subject to possible payment reductions. However, if you are also a Medicare Fee-for Service providers and cannot successfully demonstrate meaningful use, you will have a payment reduction in your Medicare reimbursement starting in 2015, even if you never received an incentive payment or only participate in the Medicaid EHR incentive program.
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Healthcare IT

So HIPAA and HITECH compliance are underway. Fines and penalties have been levied on organizations who fell victim breaches and data loss. Office of Civil Rights (OCR) and Attorney General’s office (AG) can pursue fines on behalf of the people; since they will be allowed to keep portion of fines they collect, we can expect increased compliance efforts from both agencies.

Larger hospitals, clinics and associated practices are already in the process of ensuring compliance (or have plans to get started soon) but what are the smaller, independent clinics and practitioners in the underserved communities doing to ensure compliance? They also need to meet the same compliance requirements, however, they do not have the same resources as their larger counter parts.

Then there is the EMR/EHR portion, which is not really a part of HIPAA and HITECH, but part of American Recovery and Reinvestment Act (ARRA) which provides up to $44,000 per doctor for Medicaid and $63,000 per doctor for Medicare – yes, that’s per doctor and not practice. How can the smaller clinics and practices ensure that they qualify to receive the portion of the $20 billion of the incentive?

Much information is available on the Internet about HIPAA and HITECH compliance, and ARRA EMR incentive.  In an effort to prevent digital divide we will try to distill the information and provide relevant content to help smaller clinics and practices working  within underserved communities to meet HIPAA and HITECH compliance and implement EMR solution.

© NetFunction Inc. and Adventures in HIT and BIT, 2010.

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