Payment Changes for FSY 2015

Payment Changes for FSY 2015

 

The Centers for Medicare and Medicaid Services (CMS) is reminding eligible professionals (EPs) participating in the Medicare EHR Incentive Program that they may receive payment changes on January 1, 2015. To avoid payment changes, EPs must demonstrate meaningful use (MU) before 2015.

 

Eligible professionals participating in the Medicare EHR Incentive Program may be subject to payment adjustments beginning on January 1, 2015. CMS will determine the payment adjustment based on meaningful use data submitted prior to the 2015 calendar year. Eligible professionals must demonstrate meaningful use prior to 2015 to avoid payment adjustments.

Determine how your EHR Incentive Program participation start year will affect the 2015 payment adjustments:

 

If you began in 2011 or 2012…
If you first demonstrated meaningful use in 2011 or 2012, you must demonstrate meaningful use for a full year in 2013 to avoid the payment adjustment in 2015. 

If you began in 2013…
If you first demonstrated meaningful use last year, you needed to demonstrate meaningful use for a 90-day reporting period to avoid the payment adjustment in 2015.

If you plan to begin in 2014…
If you first demonstrate meaningful use in 2014, you must demonstrate meaningful use for a 90-day reporting period in 2014 to avoid the payment adjustment in 2015. This reporting period must occur in the first 9 months of calendar year 2014, and eligible professionals must attest to meaningful use no later than October 1, 2014, to avoid the payment adjustment. 

Avoiding Payment Adjustments in the Future
You must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years. 

If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the payment adjustments. You may demonstrate meaningful use under either Medicare or Medicaid. 

If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to these payment adjustments.

Criteria for Reporting Clinical Quality Measures

Criteria for Reporting Clinical Quality Measures 

Beginning in 2014, the reporting of clinical quality measures (CQMs) will change for all providers. EHR technology that has been certified to the 2014 standards and capabilities will contain new CQM criteria, and eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) will report using the new 2014 criteria regardless of whether they are participating in Stage 1 or Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Although clinical quality measure (CQM) reporting has been removed as a core objective for both EPs and eligible hospitals and CAHs, all providers are required to report on CQMs in order to demonstrate meaningful use.

2013

Eligible Professionals (EPs), will continue to report from the 44 measures finalized for Stage 1 in the same schema laid out for Stage 1 -  3 core/alternate core 3 additional measures for EPs

Eligible hospitals and CAHs will continue to report the 15 measures finalized for Stage 1

Beginning in 2012 and continuing in 2013, there are two reporting methods available for reporting the Stage 1

eReporting Pilots: Physician Quality Reporting System EHR Incentive Program Pilot for EPs

eReporting Pilot for eligible hospitals and CAHs

 

2014 and Beyond  

EPs must report on 9 of the 64 approved CQMs Recommended core CQMs – encouraged but not required 9 CQMs for the adult population 9 CQMs for the pediatric population NQF 0018 strongly encouraged since controlling blood pressure is high priority goal in many national health initiatives, including the Million Hearts campaign  

Selected CQMs must cover at least 3 of the National Quality Strategy domains

Eligible Hospitals and CAHs must report on 16 of the 29 approved CQMs Selected CQMs must cover at least 3 of the National Quality Strategy domains  

Beginning in 2014, all Medicare-eligible providers beyond their first year of demonstrating meaningful use must electronically report their CQM data to CMS. (Medicaid EPs and hospitals that are eligible only for the Medicaid EHR Incentive Program will electronically report their CQM data to their state.)

What is Meaningful Use

 

 

Meaningful Use

Meaningful use (MU), in a health information technology (HIT) context, defines the use of electronic health records (EHR) and related technology within a healthcare organization. Achieving meaningful use also helps determine whether an organization will receive payments from the federal government under either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program.

According to the provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009,organizations that are eligible for the Medicare EHR Incentive Program and achieve meaningful use by 2014 will be eligible for incentive payments; those who have failed to achieve that standard by 2015 may be penalized. To receive the maximum reimbursement, physicians and hospitals must achieve stage 1 of meaningful use of EHR for at least a 90-day period within the 2011 or 2012 federal fiscal year and for the entire year thereafter.
Those eligible for the Medicaid program must demonstrate meaningful use by 2016 in order to receive incentive payments.
The Centers for Medicare Medicaid Services (CMS) worked with the Office of the National Coordinator for Health IT and other parts of Department of Health and Human Services (HHS) to establish regulations for stage 1 of the meaningful use incentive program.
The working group will also establish criteria to determine stages 2 and 3 of meaningful use. Criteria for stage 2 of meaningful use, which will begin in 2014, have been proposed and are expected to be finalized in early 2012. Criteria for stage 3 of meaningful use will be defined at a later date.


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