Stimulus Dollars: Medicare vs. Medicaid

During Part One of our recent Tele-class series “HITECH and Meaningful Use: What You Need to Know,” Sheryl Cherico, founder of MDTechPro, a national healthcare IT company, clarified a lot of information as it relates to stimulus dollars and meaningful use. Many questions were raised both in advance of the tele-class and afterward in regard to the differences between the Medicare Stimulus Program and the Medicaid Stimulus Program.

Please find below a synopsis of each of the programs:

1. Eligible Providers  -Medicare 

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

 Medicaid

  • Physicians
  • Nurse Practitioners
  • Certified Nurse – Midwife
  • Dentists
  • Physician Assistants who practice in a FQHC (Federally Qualified Health Center) or RHC (Rural Health Center) that is lead by a physician assistant.

2. The Medicare EHR Incentive Program starts in 2011 and continues through 2016.

3. The Medicaid EHR Incentive Program can start as early as 2011 and continues through 2021. The last year to begin participation in the Medicaid Incentive Program is 2016.

4. To qualify for the Medicaid Incentive Program, 30 percent of the eligible provider’s patient encounters must be Medicaid. The threshold is 20 percent for pediatricians.

5. Eligible Professionals who demonstrate meaningful use of a certified EHR technology can receive up to a maximum of $44,000 over 5 years under the Medicare EHR Incentive Program. To receive this maximum, however, Medicare eligible professionals must begin participation by 2012.

6. Medicare payments to Eligible Professionals are tied to 75 percent of the physician’s annual allowed charges up to the maximum annual bonus.

7. For each year past 2012 that Medicare Eligible Professionals demonstrate meaningful use of a certified product, the maximum incentive bonus possible is reduced. If implemented in 2013, the maximum incentive payment is $39,000 over three years. If implemented in 2014, the maximum incentive payment is $24,000 over two years.

8. For 2015 and later, Medicare Eligible Professionals who do not successfully demonstrate meaningful use will have a payment adjustment to their Medicare reimbursement.

9. Medicaid Eligible Professionals can receive up to $63,750 over 6 years if they begin participation at any time between now and 2016. There is no reduction in maximum incentive payment potential no matter when a Medicaid Eligible Professional begins participation provided they do no later than 2016.

10. The incentive payments for Medicaid are based on the net cost of purchasing, implementing and maintaining an EHR and are considered to be a flat fee reimbursement. The Medicaid incentive calculation is not tied to reimbursement rates or claims in any way.

11. States do not have to offer the Medicaid EHR Incentive Program. They area able to make that decision on a voluntary basis. As of January 2011, registration was opened in the following states: Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee and Texas. It is expected that other states will follow suite during the spring and summer of 2011. Click here for more information about expected Medicaid EHR Programs in your state. www.cms.gov/apps/files/medicaid-HIT-sites/

12. There are no penalties for not adopting associated with the Medicaid Program.

13. Professionals who are eligible for both the Medicare and the Medicaid EHR Incentive Program must choose one or the other. An Eligible Professional may switch between the Medicare and Medicaid programs one time.

14. An Eligible Professional in the Medicare program may also participate in the PQRI system but is not eligible to receive incentive payments through the ePrescribing incentive program.

15. Eligible Professionals in the Medicaid program are eligible to receive incentive payments from both the PQRI program and the ePrescribing incentive program provided they meet the eligibility requirements of each.

16. Eligible providers within the same practice may choose to participate with different EHR Incentive Program. For example: In a two-physician practice, one may opt in with the Medicare program and one with the Medicaid program.

Bottomline…

How do you decide between Medicare and Medicaid? Do the math.

  • Do you meet the eligibility requirements for the Medicaid program?
  • Do you have Nurse Practitioners in your practice (who qualify under the Medicaid and not the Medicare Incentive Program)?
  • Will your state participate in the Medicaid Incentive program?
  • Where are you in the evaluation, selection and installation of an EHR system? Will you meet the 2012 deadline to demonstrate meaningful use in order to receive the maximum Medicare incentive of $44,000 per eligible provider?
  • Does each Eligible Professional have enough annual Medicare allowed charges so that 75 percent of those equal the maximum Medicare incentive payment each year?
  • Are you currently receiving incentive payments through the ePrescribing incentive program? You are eligible to continue receiving them with participation in the Medicaid program but not the Medicare program.

Have you already made this decision? If so, we’d love to hear about your decision-making process and what made you decide to participate in one over the other. Email us at editor@efficiencyinpractice.com.



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