Medicare-eligible professionals (EPs) who do not demonstrate Meaningful Use for the Medicare EHR Incentive Program may be subject to a payment adjustment beginning Jan. 1, 2015.
For EPs who entered the program between 2011 and 2013, this year’s participation will determine the 2015 payment adjustment. To ensure that Medicare EPs are aware of the adjustments — and how to avoid them — PhysBizTech recently spoke to Rob Anthony, deputy director of the HIT Initiatives Group at the Centers for Medicare & Medicaid Services, which administers the EHR Incentive Programs.
Q: Could you clarify the distinction between Medicare and Medicaid providers, as it relates to this program? It is our understanding that providers that only participate in the Medicaid EHR Incentive Program and who do not bill Medicare are not subject to payment adjustments.
A: It is accurate to say that payment adjustments are only applicable on the Medicare side. However, there are a number of eligible professionals who are eligible for both Medicare and Medicaid. If you are a physician who is eligible for both, and you’ve decided to participate in Medicaid, that’s perfectly fine. We share information with states about who has attested [for the Medicaid program]. But you have to demonstrate Meaningful Use along the same timeline on the Medicaid side as you do on the Medicare side to avoid payment adjustments.
Q: Is there a range of potential adjustments that would come into play?
A: It’s not really a range. Congress dictated that there would be a payment adjustment of 1 percent per year, and it would be cumulative for every year that you are not a Meaningful User.
They provided what at first blush is a complicated cap to this. It makes the cap on the payment adjustment dependent upon how many providers are actually Meaningful Users.
The idea here was to really spur the amount of growth in Meaningful Use and incentivize providers to become Meaningful Users.
Essentially, the way the cap works is if there are not enough Meaningful Users — less than 75 percent of EPs who are not Meaningful Users — then the maximum amount of the payment adjustments could be as high as 5 percent.
However, if we have reached that 75 percent threshold, then the maximum cap is limited at 3 percent.
Q: It’s a bit confusing to a layperson.
A: We often get the question about the cumulative cap. I always try to stress a couple of points: First, you have to demonstrate Meaningful Use every year to avoid the payment adjustment. So even if you have demonstrated once, you have to keep demonstrating it to avoid the payment adjustments.
If you end up not demonstrating Meaningful Use for one year, you get assessed a payment adjustment. By becoming a Meaningful User in the next year, you reset the clock.
Q: Are there other areas where you are getting common questions, particularly with small practitioners?
A: One question we get a lot is about EPs in the same practice. What if one EP misses Meaningful Use? Would all the other EPs in the practice be subject to the payment adjustment?
It’s a good question because we tend to think very much along the lines of practices because that’s how we implement EHR systems. But incentive payments and payment adjustments are always based on the individual EP. So just because one EP does not manage to become a Meaningful User does not mean that all EPs in the same practice would be assessed the payment adjustment.
It comes down to your individual performance as an EP…whether you have individually become a Meaningful User.
So that’s an important point — and a good reason why everyone in the practice should be striving to be a Meaningful User.
Q: EPs should know about potential hardship exemptions, too, correct?
A: Yes, we have set up several different categories for hardship exceptions based on infrastructure. So if you are facing insurmountable barriers to getting infrastructure, or if there is not sufficient broadband Internet access in your area, we instituted a hardship exception for newly practicing EPs and newly opened hospitals. It’s time-limited, but it’s basically set up so that you don’t go into practice and immediately be subject to a payment adjustment. It gives you an opportunity to become a Meaningful User.
There’s also the category of an unforeseen circumstances. Hurricane Sandy is a great example of what we would call an unforeseen circumstance.
In general, most EPs are asking hardship exceptions in relation to patient interaction. Basically, if you lack face-to-face interactions with patients, or you have telemedicine interactions with patients, you really don’t provide follow-up care. For example, we provide automatic processing of hardship exceptions for anesthesiologists, radiologists, and pathologists. Most of the EPs within those specialties don’t have many face-to-face interactions with patients in what we think of as the typical office visit with patients. Most of them do not do a continuation of care beyond the initial consultation.
But there are certainly other specialists who fall into that category, and there will be an ability to apply for that hardship exception.
We have posted an FAQ that indicates for pathologists, anesthesiologists, and radiologists, which codes you have to enter in our Provider Enrollment, Chain, and Ownership System [PECOS] to automatically receive that hardship exception. Everything else will be on an application basis and will be individually reviewed.
Q: Are there online resources that we should draw to the attention of small-practice physicians?
A: We have a tip sheet for EPs and one for hospitals. It provides an overview of payment adjustments and hardship exceptions. It’s a good overview of what payment adjustments look like for the program.
Obviously, the information for hardship exceptions is just general at this point in time, but it will at least give people an idea of what the categories are. So I highly recommend people taking a look at that.
And I always recommend that people get on our listserv because as we release more information about payment adjustments specifically or hardship exceptions, that’s how we would push out that information.
Visit CMS’s EHR Incentive Program website for additional news and resources on the transition.
Frank Irving is the Editor at PhysBizTech, a publication of MedTech Media that provides business and technology intelligence to forward-thinking medical practices.
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