Electronic Medical Records (EMR) Frequently Asked Questions

Who is Eligible for Incentive Payments?
What is the definition of an Eligible Professional (EP); what are the Participation Criteria?
What is a Meaningful User?
When must EP’s report; what is the reporting period?
How much will EPs be paid per year?
Are there penalties if EPs don’t participate?

1. Who is Eligible for Incentive Payments?
The HITECH Act establishes incentive payments under the Medicare and Medicaid programs for certain professionals and hospitals that meaningfully use certified EHR technology.

2. What is the definition of an Eligible Professional (EP); what are the Participation Criteria?
A doctor of medicine or osteopathy, a doctor of dental surgery or dental medicine, a doctor of podiatric medicine, a doctor of optometry, or a chiropractor.

Medicare Fee-for-Service
Incentive payment amount, subject to an annual limit, equal to 75 percent of the Secretary’s estimate of the Medicare allowed charges for covered professional services.

Hospital-based EPs are not eligible

Medicaid Professionals Program Eligibility
Five types of Medicaid professionals: Physicians, dentists, certified nurse-midwives, nurse practitioners, and physician assistants practicing in an FQHC or RHC that is so led by a physician assistant. EP must have at least 30 percent patient volume attributable to those who are receiving Medicaid over any continuous 90-day period (pediatricians 20%).

3. What is a Meaningful User?
Common Definition of Meaningful Use Under Medicare and Medicaid
(1) Demonstrates use of certified EHR technology in a meaningful manner;
(2) Demonstrates that certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of health care
(3) Using its certified EHR technology, submits to the Secretary, in a form and manner specified by the Secretary, information on clinical quality measures and other measures.

An EP must have 50 percent or more of their patient encounters during the EHR reporting period at a practice/location or practices/locations equipped with certified EHR technology.

4. When must EP’s report; what is the reporting period?
An EP or eligible hospital must meaningfully use certified EHR technology for the EHR reporting period of the relevant payment year.

For the first payment year only…, any continuous 90-day period within a payment year in which an EP or eligible hospital successfully demonstrates meaningful use of certified EHR technology. For the second payment year and all subsequent payment years…, the EHR reporting period be the entire payment year.

The earliest start date for EHR reporting period [will] be the first day of the payment year.

5. How much will EPs be paid per year?
[Medicare Recipients]

For the EP’s first payment year…, $15,000 (or, $18,000 if the EP’s first payment year is 2011 or 2012)
For the EP’s second payment year, $12,000
For the EP’s third payment year, $8,000
For the EP’s fourth payment year, $4,000
For the EP’s fifth payment year, $2,000

6. Are there penalties if EPs don’t participate?
In general, beginning in 2015, if an EP is not a meaningful EHR user…, then the Medicare physician fee schedule amount for covered professional services furnished by the EP during the year…is adjusted to equal the ‘applicable percent’ of the fee schedule amount.

For 2015, 99 percent, for 2016, 98 percent; and for 2017 and each subsequent year, 97 percent.

Need more information?

Print our PDF brochure for more information

Make sure to contact us today to speak with a representative regarding our medical billing service.