CMS Deputy Director Offers Tips On Avoiding EHR Incentive Payment Adjustments

Posted on by Frank J. Rosello

Medicare eligible professionals (EPs) who do not demonstrate meaningful use for the Medicare EHR Incentive Program may be subject to a payment adjustment beginning Jan. 1, 2015.


For EPs who entered the program between 2011 and 2013, this year’s participation will determine the 2015 payment adjustment. To ensure that Medicare EPs are aware of the adjustments – and how to avoid them –- Healthcare Finance News’ sister publication, PhysBizTech, recently spoke to Rob Anthony, deputy director of the HIT Initiatives Group at the Centers for Medicare & Medicaid Services, which administers the EHR Incentive Programs.


Q: How would you assess the level of awareness among Medicare EPs about potential payment adjustments?


A: Although we think a lot of people know what’s coming for physicians in 2015, some folks are not aware of the payment-adjustment component to the program. We’re trying to increase awareness because certain things need to happen relatively soon.


Q: Could you clarify the distinction between Medicare and Medicaid providers, as it relates to this program? It is our understanding that providers who only participate in the Medicaid EHR Incentive Program and who do not bill Medicare are not subject to payment adjustments.


A: It is accurate to say that payment adjustments are only applicable on the Medicare side. However, there are a number of eligible professionals who are eligible for both Medicare and Medicaid. If you are a physician who is eligible for both, and you’ve decided to participate in Medicaid, that’s perfectly fine. We share information with states about who has attested [for the Medicaid program]. But you have to demonstrate meaningful use along the same timeline on the Medicaid side as you do on the Medicare side to avoid payment adjustments.


Q: Let’s review the different timeframes regarding when Medicare EPs first demonstrated meaningful use:

  • The first timeline applies to those who demonstrated meaningful use in 2011 or 2012; they have to demonstrate meaningful use for a full year in 2013 to avoid adjustments in 2015.
  • Then there are those who are beginning this year, calendar year 2013; they must demonstrate meaningful use for a 90-day reporting period in 2013.
  • And then there are those who will first demonstrate meaningful use in 2014; they must demonstrate for a 90-day reporting period in 2014 with the special provision that it must occur in the first nine months of calendar year 2014, and must be attested to no later than Oct. 1, 2014.

A: Right. October 1 the drop-dead deadline for people who are getting involved in 2014.


Q: Is there a range of potential adjustments that would come into play?


A: It’s not really a range. Congress dictated that there would be a payment adjustment of 1 percent per year, and it would be cumulative for every year that you are not a meaningful user.


They provided what at first blush is a complicated cap to this. It makes the cap on the payment adjustment dependent upon how many providers are actually meaningful users.


The idea here was to really spur the amount of growth in meaningful use and incentivize providers to become meaningful users.


Essentially the way that the cap works is that if there are not enough meaningful users – less than 75 percent of EPs who are not meaningful users – then the maximum amount of the payment adjustments could be as high as 5 percent.


However, if we have reached that 75 percent threshold, then the maximum cap is limited at 3 percent.


Q: It’s a bit confusing to a layperson.


A: We often get the question about the cumulative cap. I always try to stress a couple of points: First, you have to demonstrate meaningful use every year to avoid the payment adjustment. So even if you have demonstrated once, you have to keep demonstrating it to avoid the payment adjustments.


If you end up not demonstrating meaningful use one year, you get assessed a payment adjustment. By becoming a meaningful user in the next year, you reset the clock.


Q: Are there other areas where you are getting common questions, particularly with small practitioners?


A: One question we get a lot is about EPs in the same practice. What if one EP misses meaningful use? Would all the other EPs in the practice be subject to the payment adjustment?


It’s a good question because we tend to think very much along the lines of practices because that’s how we implement EHR systems. But incentive payments and payment adjustments are always based on the individual EP. So just because one EP does not manage to become a meaningful user does not mean that all EPs in the same practice would be assessed the payment adjustment.


It comes down to your individual performance as an EP … whether you have individually become a meaningful user.


So that’s an important point – and a good reason why everyone in the practice should be striving to be a meaningful user.


Q: EPs should know about potential hardship exemptions, too, correct?


A: Yes, we have set up several different categories for hardship exceptions based on infrastructure. So if you are facing insurmountable barriers to getting infrastructure, or if there is not sufficient broadband Internet access in your area, we instituted a hardship exception for newly practicing EPs and newly opened hospitals. It’s time-limited, but it’s basically set up so that you don’t go into practice and immediately be subject to a payment adjustment. It gives you an opportunity to become a meaningful user.


There’s also the category of unforeseen circumstance. Hurricane Sandy is a great example of what we would call an unforeseen circumstance.


In general, most EPs are asking hardship exceptions in relation to patient interaction. Basically, if you lack face-to-face interactions with patients, or you have telemedicine interactions with patients, you really don’t provide follow-up care. For example, we provide automatic processing of hardship exceptions for anesthesiologists, radiologists and pathologists. Most of the EPs within those specialties don’t have a great deal of face-to-face interactions with patients in what we think of as the typical office visit with patients. Most of them do not do continuation of care beyond the initial consultation.


But there are certainly other specialists who fall into that category, and there will be an ability to apply for that hardship exception.


We have posted an FAQ that indicates for pathologists, anesthesiologists and radiologists, which codes you have to enter in our Provider Enrollment, Chain and Ownership System [PECOS] to automatically receive that hardship exception. Everything else will be on an application basis and will be individually reviewed.


Q: But outside of those three defined specialties, it’s still a bit early to get into individual cases?


A: People are asking for a lot more information now about what they need to submit. We don’t have that hardship exception process open to the public, primarily because we are not assigning payment adjustments right now. But as we get close to that date, we’ll not only have a mechanism by which people can submit paperwork, but also some guidance as to what type of documentation they’ll need to have, and what we will and won’t grant.


There are also a number of providers who are in a situation where they really do not control whether an EHR gets implemented in their particular practice location. If they are in multiple locations, for instance, that can prevent them from reaching the level of conducting 50 percent of their patient encounters in places that have a certified EHR. More and more, that is the case where physicians are working in multiple locations … whether that’s a hospital and a practice or whether that’s multiple practices. So there is going to be a hardship exception category that people can apply for when they really don’t have any input into the decisions of whether EHRs are made available at particular locations. We’ll be providing additional information about what needs to be documented for that when we open up the hardship exception process.


Q: When does the hardship exception process kick in?


A: If you haven’t attested yet as a meaningful user, we’ll be looking for something in those first nine months of 2014. So we won’t open up the hardship exception process until 2014.


Q: Are there online resources that we should draw to the attention of small-practice physicians?


A: We have a tip sheet for EPs and one for hospitals. It provides an overview of payment adjustments and hardship exceptions. It’s a good overview of what payment adjustments look like for the program.


Obviously the information for hardship exceptions is just general at this point in time, but it will at least give people an idea of what the categories are. So I highly recommend people taking a look at that.


And I always recommend that people get on our listserv, because as we release more information about payment adjustments specifically or hardship exceptions, that’s how we would push out that information.


Q: Is there anything else we haven’t covered as far as the timeline?


A: The only other question we get fairly frequently is whether it’s too late. And that’s why we’re trying to push out this information now. It isn’t too late. You still have six months left in 2013 if you want to become a meaningful user. You still have the first nine months of 2014. Obviously, we’d rather that people would do it this year because you have more of a chance of getting an incentive payment if you begin in 2013. But there is still time to get your 90 days in.


If you haven’t started thinking about it, start thinking about it now. We don’t want to see anyone get hit with a payment adjustment; we’d rather see that providers become meaningful users. It’s good for them, and it’s great for patients.

Article written by Frank Irwin, Editor with PhysBizTech

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