Health Center Regulatory Issues

Electronic Health Records Incentives and Meaningful Use Penalties- A New Round of Questions Answered

Recently, we have received several inquiries from health centers regarding Electronic Health Record (EHR) Incentives and “meaningful use” (MU) requirements and penalties as prescribed in the HITECH Act. As most health centers will recall, due to the more generous benefits available under the Medicaid incentive program, virtually all eligible health center providers opted to participate in the Medicaid versus Medicare EHR incentive program. Health center organizations were not eligible as entities due to the HITECH Act’s focus on “eligible professionals” not health center organizations. Many readers will also recall that there were no downward payment adjustments under the Medicaid incentive program for failing to demonstrate meaningful use, only the potential loss of incentives themselves. However, as the date for Medicare payment adjustments approaches (January 1, 2015) some health centers are wondering whether they should be worried. Here are some Frequently Asked Questions (FAQs) and the answers.
Q: Are health center providers who participated in the Medicaid EHR incentive payment program subject to downward adjustments to their health center’s base Medicaid payment rate?
A: No. The Medicaid EHR Incentive program does not have payment penalties for failure to demonstrate meaningful use though participating providers do have to demonstrate meaningful use to continue receiving incentive payments.
Q: Are health centers’ Medicare FQHC claims subject to downward adjustment due to failure to demonstrate meaningful use?
A: No. The HITECH Act and its accompanying regulations indicate that for providers who fail to meet meaningful use standards there is a payment adjustment to the “covered professional services” billed by the eligible professional under the Medicare physician fee schedule. Health center Medicare FQHC payments are not made under the fee schedule.
Q: Could health center providers be facing payment adjustments January 1, 2015 to Medicare services billed outside of the FQHC rate under the Medicare Part B fee schedule if they fail to demonstrate meaningful use?
Yes.
Q: What are the payment adjustments for providers who fail to demonstrate meaningful use?
The non-FQHC Medicare fee schedule claims of eligible health professionals at health centers could be adjusted down by 1% per year capping out at 5%.
Q: Which professionals are subject to these adjustments?
The fee schedule claims of all eligible professionals who fail to demonstrate meaningful use are subject to adjustments January 1, 2015. Eligible professionals are essentially all physicians as defined in the Medicare stature, such as: a doctor of medicine or osteopathy, a doctor of dental surgery or medicine, a doctor of podiatric medicine, a doctor of optometry, or a chiropractor. Eligible professionals who demonstrated meaningful use in Medicare or Medicaid in 2013 are not subject to 2015 reductions but will need to demonstrate meaningful use again in 2014 to avoid 2016 payment adjustments.