Electronic Health Record (E.H.R.) Incentive Programs for Pediatricians

December 10, 2010 in Uncategorized by support Team  |  Comments Off on Electronic Health Record (E.H.R.) Incentive Programs for Pediatricians

The HITECH Act has an Electronic Health Record (EHR) incentive program paid via either Medicare or Medicaid. Since Pediatricians do not have Medicare Patients, their opportunity to participate is via the EHR incentive program provided by the Medicaid program. The Medicaid program starts as early as 2011 and eligible providers in a Pediatric Group (MD, DO, NP) can each receive up to $63,750 over a six year period. Unlike Medicare, eligible professionals have until 2016 to implement a certified E.H.R. system and still qualify for the maximum incentive. The HITECH act has recommendations to the state of the threshold for this incentive money. A provider must have at least 20% of their total patient volume be via Medicaid/Managed Medicaid/Children Health Insurance Program (CHIP) Patients during a 90-day measurement period. If a provider has 20% Medicaid volume during a 90-day period, they are eligible for up to $42,500 over a six-year period. If a provider has over 30% volume during a 90-day measurement period, they are eligible for up to $63,750 over a six-year period. Note that the “up to” is dependent on maintaining these thresholds each year as well as implementing a certified EHR system to show meaningful use. The table below provides a summary by year.

Medicaid Eligible Professional (20% – 30% Medicaid/Managed Medicaid/CHIP vol.)

Medicaid Volume

Year

20%-30%

>30%

1

$14,165

$21,250

2

$ 5,667

$ 8,500

3

$ 5,667

$ 8,500

4

$ 5,667

$ 8,500

5

$ 5,667

$ 8,500

6

$ 5,667

$ 8,500

Total

$42,500

$63,750

Medicaid, different than Medicare, is administered by the state. The state Medicaid programs are required to verify the eligibility of the provider as well as disperse the payments. Per the CMS.gov website: “The Medicaid EHR Incentive Program is voluntarily offered by individual states and territories and may begin as early as 2011, depending on the state.”

The question and answer section on the CMS website related to the Medicaid EHR program I found to be a useful resource (22 pages). One of the questions is if the State Medicaid program needs to verify the “installation” or “signed contract” of a certified EHR . The answer on the CMS website concludes that: “Thus, a signed contract indicating that the provider has adopted or upgraded would be sufficient.”

There are details to verify and implement to insure eligibility and then receive disperse these funds. I recommend that each office invest some time learning about the HITECH act. Also, having a knowledgeable EHR vendor and/or consultant should greatly reduce the detail knowledge needed within each office.

http://www.cms.gov/EHRIncentivePrograms/

https://www.cms.gov/apps/media/press/factsheet.asp?Counter=3793&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date

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