Medicare Eligible Professional
The Medicare EHR incentive program for Eligible professionals (EPs) starts in 2011 and continues through 2016. Eligible professionals can participate for 5 years throughout the duration of the program. The last year to begin participation is 2014.


The incentives are based on individual providers. Therefore, if you are part of a practice, each eligible professional may qualify for an incentive payment provided they successfully demonstrate meaningful use. Each EP is only eligible for one incentive payment each year, regardless of how many practices or locations they provide services.
Eligibility for Medicare EHR Incentive Program – Eligible Professionals (EPs)
Under the Medicaid EHR incentive program, EPs include the following:



*   Doctors of Medicine or Osteopathy
*   Doctors of Dental Surgery or Dental Medicine
*   Doctors of Podiatric Medicine
*   Doctors of Optometry
*   Chiropractors

 
NOTE: Medicare EPs may not be hospital-based. A Medicare EP is considered hospital-based if 90% or more of the EP's services are performed in a hospital inpatient or emergency room setting.
 
Participating in the EHR Incentive Program and Other Current CMS Incentive Programs
 
This is a new program, and it is separate from other active CMS incentive programs, such as Physicians Quality Reporting Initiative (PQRI) and e-Prescribing. If you participate as a Medicare eligible professional, you cannot receive incentive payments from both the Medicare EHR incentive program and the e-Prescribing program in the same year. If you participate as a Medicaid EP, you may participate in both the Medicaid EHR incentive program and the e-Prescribing program at the same time, as long as you meet the eligibility requirements for both programs. If you want to participate in the Medicare EHR incentive program AND are currently participating in the e-Prescribing incentive program, you need to decide which incentive program you want to participate. The e-Prescribing incentive program is based on allowable submitted charges during the reporting period, while the EHR incentive program provides a determined incentive payment if the requirements of the program are met. For most, the EHR incentive program will provide the greater monetary value.

 
NOTE: If you register and attest for the Medicare EHR incentive program, then you will no longer be able to participate in the e-Prescribing program. Physicians can participate in the Physicians Quality Reporting Initiative (PQRI) at the same time as the Medicare and Medicaid EHR incentive programs, as long as they meet eligibility requirements for both programs.
 
Incentive Payments
 
The qualification criteria for incentives (i.e., meeting specified HIT standards, policies, implementation specifications, timeframes, and certification requirements) are still in development, and will be defined through regulation and additional guidance materials. However, CMS generally expects that under Medicare, “meaningful EHR users” would demonstrate each of the following: meaningful use of a certified EHR, the electronic exchange of health information to improve the quality of health care, and reporting on clinical quality and other measures using certified EHR technology. Medicaid programs will determine their own requirements in line with the Medicaid-related provisions of the Recovery Act. Funds will be distributed through Medicare and Medicaid incentive payments to EPs and hospitals who are “meaningful EHR users.” CMS intends to publish a proposed rule in late 2009 to propose a definition of meaningful use of certified Electronic Health Records (EHR) technology and establish criteria for the incentives programs. CMS is working extensively with the Office of the National Coordinator for Health Information Technology (ONC) to identify the proposed criteria.
 
Incentive Payments


To qualify for Medicare incentive payments, Medicare eligible professionals must successfully demonstrate meaningful use for each year of participation in the program. For calendar years 2011-2016, meaningful EHR users can receive up to $44,000 over 5 years under the Medicare incentive program. Incentive payments are made based on the calendar year. To get the maximum incentive payment, Medicare eligible professionals must begin participation by 2012. 
 
Payment Amounts
Medicare EP Qualifies to Receive First Payment in 2011
Medicare EP Qualifies to Receive First Payment in 2012
Medicare EP Qualifies to Receive First Payment in 2013
Medicare EP Qualifies to Receive First Payment in 2014
Medicare EP Qualifies to Receive First Payment in 2015
Payment Amount in 2011
$18,000.00
$0.00
$0.00
$0.00
$0.00
Payment Amount in 2012
$12,000.00
$18,000.00
$0.00
$0.00
$0.00
Payment Amount in 2013
$8,000.00
$12,000.00
$15,000.00
$0.00
$0.00
Payment Amount in 2014
$4,000.00
$8,000.00
$12,000.00
$12,000.00
$0.00
Payment Amount in 2015
$2,000.00
$4,000.00
$8,000.00
$8,000.00
$0.00
Payment Amount in 2016
$0.00
$2,000.00
$4,000.00
$4,000.00
$0.00
TOTAL Incentive Payments
$44,000.00
$44,000.00
$39,000.00
$24,000.00
$0.00
 
Important! 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.

 
Extra incentives are available - The amount of the annual EHR incentive payment limit for each payments year will be increased by 10% for Medicare eligible professionals who predominantly furnish services in an area that is designated as a Health Professional Shortage Area (HPSA.)
 
NOTE: HPSA bonuses are not available for eligible professionals in the Medicaid EHR incentive program.