Government entities don’t like to use the word penalty; thus, they created the euphemism payment adjustment.
And although there’s not much you can do to challenge the status quo, you can avoid negative consequences by being prepared. So here’s what you need to know about the payment And although there’s not much you can do to challenge the status quo, you can avoid negative consequences by being prepared. So here’s what you need to know about the payment adjustments associated with the Medicare EHR Incentive Program:
1. Who is affected?
Eligible professionals (EPs) participating in the Medicare EHR Incentive Program. If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to these payment adjustments.
2. What is the basis of the adjustments?
EPs must demonstrate meaningful use of certified EHR technology prior to 2015 to avoid reduced payments. CMS will determine the payment adjustment based on meaningful use data submitted prior to the 2015 calendar year.
3. How large could the adjustment be?
What starts relatively small can grow — and quickly. Changes will be applied to the Medicare Physician Fee Schedule amount for covered professional services furnished by the EP during the year. The payment adjustment is 1 percent per year and is cumulative for every year that an EP is not a meaningful user. Maximum payment adjustment can reach as high as 5 percent in 2019.
4. How does the EHR Incentive Program timeline factor in?
If you first demonstrated meaningful use in 2011 or 2012, you must demonstrate meaningful use for a full year in 2013 to avoid a payment adjustment in 2015. Entities that didn’t start until 2013 must demonstrate meaningful use for a 90-day reporting period before the end of this year to avoid the payment adjustment in 2015. If you won’t start until 2014 the 90-day reporting period requirement applies; however, it must occur in the first nine months of the calendar year 2014. EPs have to attest no later than Oct. 1, 2014, to avoid the payment adjustment in 2015.
5. What happens beyond 2015?
EPs must continue to demonstrate meaningful use every year to avoid being paid less in the future.
6. Are there exceptions?
Perhaps. Practices may apply for hardship exceptions to avoid payment adjustments, but they will be granted only if CMS determines that circumstances pose a significant barrier to achieving meaningful use. Exceptions may include lack of sufficient Internet access in a practice area or unforeseeable occurrences such as natural disasters.
Frank Irving is the Editor at Medical Practice Insider, a publication of MedTech Media that provides business and technology intelligence to forward-thinking medical practices.
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