Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

As the industry anxiously anticipates the Proposed Rule for Stage 2 meaningful use—likely expected during HIMSS this week—many providers are still struggling to understand meaningful use Stage 1. So while we wait for the impending news story to break, let me address another question that was recently posed by a reader. 

Q: Can a physician attest and earn a Medicare EHR incentive for his second reporting year if he will be retiring in the middle of the year? 

A: To my surprise, this situation is not explicitly addressed in the regulations. One would think that a physician who works full time for part of the year would be just as eligible as one who works part time for the full year. The retiring physician, however, faces two obstacles: 1) The regulations require that an EP report for an entire calendar year after receiving a first meaningful use payment. 2) The EP must have an active enrollment record in PECOS (Medicare) to be eligible to attest—if he retires and withdraws from Medicare, he would no longer have active status. These factors suggest that a retiring physician is not eligible for an incentive (unless, of course, he times his retirement for the end of the year!)

In lieu of a definitive answer to the question, however, I offer the following food for thought: 1) Couldn’t the retiring physician simply wait until December 31 to attest and then report on the full calendar year? 2) What if he simply postpones surrendering his PECOS enrollment until the end of the year? (According to a local Medicare contractor, nothing prohibits him from doing that even though he would no longer be submitting claims.) If there are countervailing reasons not to do this that readers are aware of—and there may well be—please share your insights by commenting below. 

(Note: This is not an issue for retiring physicians in their first incentive year since they attest immediately upon the conclusion of their 90-day reporting period.)

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

A reader posed the following question: What happens if a physician receives a Medicaid EHR incentive in 2011, no longer meets the 30% eligibility threshold for Medicaid in 2012 and therefore elects not to apply for any incentive that year, and then has to switch to the Medicare program in 2013 because his Medicaid volume is still too low to qualify under Medicaid? Below is a follow-up to a prior post, (“Switching Between Medicare and Medicaid Incentive Programs”), that provides the additional information needed to not only answer this particular question, but also to evaluate the financial impact of other scenarios in which a provider might skip years and/or switch between programs. 

Here are the rules regarding switching programs and skipping years:

• An EP can switch between programs only once after receiving his first incentive payment, and the switch must occur in 2014 or earlier.
• When an EP switches programs, he is “placed in the payment year he would have been in had he begun in—and remained in—the program to which he has switched.”
• Medicare and Medicaid treat skipping years differently. Medicare incentives require that payment years be consecutive—so while an EP can skip a year, if he does, he forfeits that year’s incentive permanently. Medicaid incentive payments, on the other hand, can be non-consecutive with no adverse impact on total available revenue.
• The last year that payments will be available also differs between the two programs. Under Medicare, no payments will be made after 2016, whereas EPs have until 2021 to earn incentives under Medicaid.
• Although an EP who switches to or from the Medicare program could—under certain circumstances—earn more than the total Medicare incentives ($44,000), in no cases would any EP be paid more than the maximum available under Medicaid ($63,750). 

To get back to the physician in the reader’s question, when he switches to the Medicare program after skipping 2012, 2013 would be considered (and paid as) his third payment year. 

Confused? To analyze the financial implications of switching programs and/or skipping a year under scenarios that might apply to your practice, make a chart and do the math—taking into account the above rules and the schedules of annual incentives.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Many physicians will be pursuing EHR incentives in 2012. Because meaningful use is not dependent upon G-codes, providers have been asking whether they need to continue putting “G-8553” on Medicare claims. The answer is YES—keep on G-Coding! 

Even though physicians who receive a Medicare EHR incentive are ineligible for an ePrescribing (MIPPA) incentive, they are still subject to future ePrescribing penalties. These penalties can be avoided by ePrescribing in 2012:

• Prevent the 2013 (1.5%) penalty – CMS is giving providers a second chance. If you failed to ePrescribe on the minimum 25 Medicare encounters in 2011, (which would have already protected you from the 2013 penalty), report G-8553 10 times between January 1 and June 30, 2012 on any Medicare claims. These claims don’t even have to be for the specified CPT “denominator” codes.
• Prevent the 2014 (2%) penalty – Report the G-code 25 times between January 1 and December 31, 2012. These claims must be associated with the specified CPT codes (typically E&M visits). 

If you are not pursuing meaningful use in 2012—or if you are, but for some reason fail to earn the incentive this year—you can still earn a 1% ePrescribing bonus under MIPPA if you report the G-Code on claims with the specified CPT codes 25 times between January and December . 

Like last year, there will be a process for requesting an exemption from the 2013 penalties, but surprisingly, the Proposed Rule did not include earning an EHR incentive as one of the justifications.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Having just experienced the attestation process firsthand as I watched an SRS client successfully attest to meaningful use, I am happy to report that this part of demonstrating meaningful use is relatively easy—a bit tedious if you are attesting for multiple providers, but not at all difficult. CMS has created a user-friendly, web-based attestation system. Assuming that your EHR provides the information you need in a useful format, you have successfully met all the required measures, and you come prepared, there should be no reason to have an unsuccessful attestation.

Here are some tips that will ensure your success:

• Register in advance: Even though you can register as late as at the time of attestation, the combined task would be overwhelming—particularly if you are attesting “on behalf of” a provider. Registering in advance ensures that everything is up-to-date in NPPES and PECOS and that you have all the necessary information.
• Make sure that all measures have been met: If your EHR does not show the percentages for measures that have thresholds, do the math yourself to verify your success on each one. CMS offers a worksheet that you might find helpful for this purpose. Verify that you have also met all other (non-numerical) measures. If you fail to satisfy even one measure, do not attest now—go back and try another reporting period.
• Have documentation for each provider:
  - Registration confirmation page with registration ID#

  - Password

  - EHR certification number

  - Reporting period dates (make sure it covers at least 90 days)

  - Printout of all meaningful use measures: numerators and denominators, exclusions and reasons

    (when there is more than one possible reason)

  - Clinical Quality Measure report: numerators, denominators, exclusions

• Do not hit “Submit” until you have reviewed the “Attestation Summary” page: Double check your data. Make sure that you have said “yes” to all yes/no measures and that your numbers are entered accurately. The summary page does not display percentages, so you have to do the math yourself to be sure that you meet the thresholds.
• Submit attestation and print the “Submission Receipt” as confirmation: If you have done everything correctly it will state that “all measures are accepted and meet MU minimum standards.”

While not necessary, I highly recommend having a second person help you attest. A second set of eyes will shorten the time the process takes and will reduce the potential for errors in posting your data.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Meaningful Use Monday posts have delved into the nitty-gritty details of meaningful use, but I know that there are many providers and practice administrators who are still trying to wrap their arms around the basics of the EHR Incentives Program. CMS has just condensed the enormous amount of information available on its website into one handy, presentation-style document that explains the program.

Called “An Introduction to the Medicare EHR Incentive Program for Eligible Professionals” (PDF), its URL identifies it as a “Beginners Guide”. (They could just as easily have named it “Meaningful Use for Dummies”, trademark infringement issues notwithstanding.) Although it is 85 slides long, the presentation is succinct, easy-to-navigate, and covers a full range of topics—including eligibility, program options, meaningful use measures, registration, attestation, other resources, etc.

Check it out! …And for more information, I invite you to browse through the comprehensive Meaningful Use Resource Center on the Government Affairs section of our company’s website (www.srssoft.com).

Wishing everyone Happy Holidays and a “Meaningful” New Year!
Lynn

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

HHS recently announced the postponement of Stage 2 Meaningful Use to 2014. The only providers who are in a position to act on this “opportunity” are those who have not yet, but still could, attest to meaningful use in 2011—but, a word of caution before you rush to attest in 2011. 

The HHS announcement “encourages any providers who have been waiting until 2012 to attest to Stage 1 meaningful use now. ….Those providers who first attest in 2011 can get three payment years for meeting the Stage 1 expectations, while those first attesting in 2012 can only get two payment years under Stage 1 criteria.” 

True. However, you must carefully weigh the benefit, (earning the $8,000 third incentive payment under the rules of Stage 1 instead of those of Stage 2), against the cost, (the permanent loss of your 2011 Medicare ePrescribing bonus money). Remember, you cannot receive incentive payments under both programs during the same year, so you maximize your total reimbursement by collecting the 1% ePrescribing bonus this year and waiting just 3 months to begin earning the $44,000 in EHR incentives over the next 5 years. There is no universally right or wrong strategy—just do the math and analyze the trade-off before making a decision.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Meaningful Use penalties—or to use the politically correct word, “adjustments”—are scheduled to begin in 2015 for providers who are not meaningful users of certified EHR technology by 2014. There’s something about the prospect of incurring a revenue reduction that seems to evoke a visceral response among providers—even among those who do not find the potential incentive money motivating.

Here’s what you need to know about the penalties:

1) Penalties apply to Medicare only.
- Adjustments will be applied as a percent of Medicare Part B Professional Fee Schedule Charges.
- They are scheduled to begin in 2015, and continue as follows:
2015: 1%
2016: 2%
2017: 3%
2018 and 2019: may increase 1%/year, at the discretion of the Secretary of HHS.

2) There has been speculation by some industry pundits that the penalties will be delayed or not implemented at all, but to rely upon that as a given would be a mistake.

3) There are no penalties associated with the Medicaid program—adjustments do not apply to Medicaid revenue. Pursuing the EHR incentives as a Medicaid provider, however, does not totally insulate a physician from the penalties. If a Medicaid provider does not become a meaningful user by 2014, the revenue he/she generates under Medicare would be subject to the adjustments above.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

EPs cannot receive EHR incentives from both Medicare and Medicaid in the same year—they must choose between the two, even if they are eligible under both programs. As discussed in a prior Meaningful Use Monday post, Medicaid is typically the EHR incentive program of choice for EPs who have a sufficiently large Medicaid volume. 

But providers must re-qualify annually, so what happens if the participating provider’s Medicaid volume drops below the 30% (or 20% peds.) threshold in a future year, making him/her no longer eligible for that program? What about an EP who initially participates as a Medicare provider, but subsequently becomes eligible for the more generous Medicaid program? As the first EHR Incentive Program participants approach year 2, they need to understand their options in this regard. 

The rule is as follows:  An EP may switch from one program to another, but only one time after receiving his/her first EHR incentive payment, and only for a payment year before 2015.  

Note: In case you are doing the math and calculating how you could game the system to increase your potential revenue, the rule goes on to say that under no circumstances can an EP’s total incentives exceed the total available under Medicaid, (i.e., $63,750).

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

A Meaningful Use Monday reader asked whether a provider who practices near the border of two states and treats patients under the two distinct Medicaid programs can participate in both EHR incentive programs. A similar question has been asked by physicians who have practice locations in two neighboring states. The answer is “No”, even if the EP meets or exceeds the 30% patient volume threshold in both states. 

EPs can receive only one incentive each year, and they must choose the state from which they wish to receive the payment. They can, however, change states on an annual basis when they re-attest—flexibility which is valuable in the event that their Medicaid volume falls below the required level in the first state and they lose eligibility for that program. 

CMS created a single registration system for both incentive programs to enable the States to check for—and make them responsible for preventing—duplicate payments, whether from two states or from Medicaid and Medicare simultaneously. My next Meaningful Use Monday post will discuss the rules for switching between the Medicaid and Medicare EHR incentive programs.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Year 1 of the EHR Incentives program is almost history. Do you have a plan for 2012? What you do next year depends on what you did this year. 

If you did not pursue meaningful use in 2011—and many Medicare providers did not, either because they were not ready yet or because they opted to earn the ePrescribing incentive under MIPPA instead—it is now time to focus on meaningful use. You can choose any 90-day reporting period in 2012 starting as late as October 3^rd, but it would be wise not to leave it to the last minute.

If you successfully attested to meaningful use in 2011, your reporting period for the second year’s incentive is a full calendar year. Regardless of which 90-day period you chose to report on for 2011, in 2012 you will report from January 1 to December 31. Incentives are tied to calendar years, so even if you completed your 2011 reporting period in September, your next period does not begin until January. Take a break from reporting, but do not abandon your meaningful use workflow.

For EPs who participate under the Medicare program, the 5 years of incentive payments must be continuous in order to earn the full $44,000 in incentives. Once you receive your first payment, skipping a subsequent year, (i.e., failing to demonstrate meaningful use), while permissible, will mean that you forfeit the payment associated with that calendar year. 

For EPs who receive a 2011 Medicaid incentive for “Adoption, Implementation, or Upgrade,” 2012 will require the demonstration of meaningful use. Since it will be your first year of meaningful use, you will only be expected to report on a 90-day period, and that period can occur any time during the year. Medicaid participants are eligible for 6 incentive payments—as opposed to 5 for Medicare providers—and unlike Medicare, the years do not have to be consecutive, as long as they are all completed by 2021. 

It’s time to start thinking about 2012.