Registration Opens for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs

On January 3, 2011, CMS opened registration for the Medicare EHR Incentive Program, and several states opened registration for the Medicaid EHR Incentive Program, including Alaska, Iowa, Kentucky, Louisiana, Michigan, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas. The Medicare & Medicaid EHR Incentive Program Registration and Attestation System Web site is located at https://ehrincentives.cms.gov/hitech/login.action, and Registration User Guides with step-by-step instructions are provided at http://tinyurl.com/24f6ef7.

A summary of the registration guidelines is available here.

While the Medicare EHR Incentive Program is administered by CMS, the Medicaid EHR Incentive Program is voluntarily offered and administered by the states. California, Missouri, and North Dakota are expected to open registration for the Medicaid Incentive Program in February 2011, with other states likely to offer the program during the spring and summer of 2011. Registration marks a major step for providers in the process of obtaining incentive payments under the EHR Incentive Programs. Under these programs, Medicare and Medicaid incentive payments totaling as much as $27 billion from 2011 to 2021 will be available for payment to eligible professionals (EPs) and eligible hospitals for the "meaningful use of certified EHR technology." Providers are encouraged by CMS to register and participate early to obtain the maximum incentive payments.

To obtain incentive payments, the EP or eligible hospital is required to (1) register for the EHR Incentive Program that it desires to participate in, and (2) attest that it has met all the incentive payment eligibility criteria (e.g., demonstration of meaningful use of certified EHR technology). A provider's EHR system is not required to be certified prior to registration; however, an EHR Certification Number will be required at the time of attestation (see the Certified Health IT Product List (CHPL) at http://onc-chpl.force.com/ehrcert for a listing of "certified" EHR products and to identify a product's corresponding certification number).

Medicare EHR Incentive Program

As mentioned above, registration for the Medicare EHR Incentive Program began on January 3, 2011 through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System Web site located at https://ehrincentives.cms.gov/hitech/login.action. The attestation feature of the Registration and Attestation System is expected to be available in April 2011 and will require the provider to state through the Web site that it has demonstrated meaningful use of certified EHR technology. EHR incentive payments are expected to start in May 2011.

Under the Medicare EHR Incentive Program, EPs and eligible hospitals are required to demonstrate meaningful use of certified EHR technology (in accordance with the Meaningful Use Final Rule published on July 28, 2010) for a continuous 90-day reporting period in the first participation year. For all subsequent participation years after the first participation year, the provider will be required to demonstrate meaningful use for the entire year, not just a continuous 90-day period. In addition, based on the Meaningful Use Final Rule, the following applies to Medicare-eligible hospitals and EPs:

Medicare-Eligible Hospitals

Demonstration of meaningful use requires that an eligible hospital (1) achieve 19 objectives (14 "core set" objectives and five additional objectives of the eligible hospital's choice out of a "menu set" of 10 additional objectives), and (2) report on 15 clinical quality measures
Eligible hospitals that have decided to begin participation in FY 2011 (i.e., October 1, 2010 to September 30, 2011) and plan to receive an incentive payment for FY 2011 must (1) begin their 90-day reporting period for demonstrating meaningful use by July 3, 2011, and (2) register and attest by November 30, 2011
To obtain the maximum incentive payment, eligible hospitals must begin participation by FY 2013 (i.e., the maximum number of years of participation is four years for an eligible hospital and the Medicare EHR Incentive Program ends in FY 2016 for eligible hospitals)
The last year for eligible hospitals to initiate participation in the Medicare EHR Incentive Program is FY 2015
For those eligible hospitals that do not successfully demonstrate meaningful use of certified EHR technology by FY 2015, payment adjustments to Medicare reimbursements will begin in 2015

Medicare EPs

Demonstration of meaningful use requires that an EP (1) achieve 20 objectives (15 core set objectives and five additional objectives of the EP's choice out of a menu set of 10 additional objectives), and (2) report on six clinical quality measures (three core measures (or if one or more of the core measures is not applicable, up to three alternate core measures) and three additional measures)
EPs that have decided to begin participation in CY 2011 (i.e., January 1, 2011 to December 31, 2011) and plan to receive an incentive payment for CY 2011 must (1) begin their 90-day reporting period for demonstrating meaningful use by October 1, 2011, and (2) register and attest by February 29, 2012
To obtain the maximum incentive payment, EPs must begin participation by CY 2012 (i.e., the maximum number of years of participation is five years for an EP and the Medicare EHR Incentive Program ends in CY 2016 for EPs)
The last year for EPs to initiate participation in the Medicare EHR Incentive Program is CY 2014
For those EPs that do not successfully demonstrate meaningful use of certified EHR technology by CY 2015, payment adjustments to Medicare reimbursements will begin in 2015

Medicaid EHR Incentive Program

Registration and attestation for the Medicaid EHR Incentive Program is determined by the state administering the program, with the states able to launch their programs starting in 2011. The initial part of the Medicaid EHR Incentive Program registration process is available through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System Web site at https://ehrincentives.cms.gov/hitech/login.action. After completing the initial part of the registration, the provider will be required to wait 24 hours before it is able to continue and complete the Medicaid registration process using the respective state's Medicaid EHR registration/eligibility verification tool. The link to the state's Medicaid EHR registration/eligibility verification tool is provided through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System Web site. However, if the provider's state has not yet launched its Medicaid EHR Incentive Program, the provider will be required to wait until the state has launched its program, before the provider is able to complete the Medicaid registration process.

The attestation process for the Medicaid EHR Incentive Program will require the provider to state through the respective state's Medicaid agency Web site (not through the attestation feature on the Medicare & Medicaid EHR Incentive Program Registration and Attestation System Web site) that it has demonstrated adoption, implementation, upgrading, or meaningful use of certified EHR technology.

Under the Medicaid EHR Incentive Program, EPs and eligible hospitals may qualify for incentive payments if they have demonstrated adoption, implementation, upgrading, or meaningful use of certified EHR technology in the first participation year. The provider is not required to demonstrate meaningful use of certified EHR technology until the second participation year.

The last year to initiate participation in the Medicaid EHR Incentive Program is CY 2016 for both EPs and eligible hospitals, with the maximum number of years of participation being six years. The Medicaid EHR Incentive Program will end in 2021.

Registration Information

Eligible hospitals should have the following information available when they register:

CMS Identity and Access Management (I&A) user ID and password
Hospital Taxpayer Identification Number (TIN)
CMS Certification Number (CCN)
National Provider Identifier (NPI)
Medicaid state/territory
Medicaid hospital type (i.e., acute care hospitals, children's hospitals)
Medicare hospital type (i.e., critical access hospitals, Subsection (d) hospitals)
EHR Certification Number, if hospital has certified EHR at the time of registration
Business address and phone information
E-mail address

EPs should have the following information available when they register:

National Plan and Provider Enumeration System (NPPES) user ID and password
National Provider Identifier (NPI)
Medicaid state/territory
EP type (i.e., physician, nurse practitioner, certified nurse-midwife, dentist, physician assistant (PA) participating in a federally qualified health center or rural health center by a PA)
EHR Certification Number, if EP has certified EHR at the time of registration
Group name (if the EP is reassigning its benefits)
Payee Taxpayer Identification Number (TIN) (if the EP is reassigning its benefits)
Payee National Provider Identifier (NPI) (if the EP is reassigning its benefits)
Business address and phone information
E-mail address

Providers Eligible for Incentive Payments Under Both Programs

Hospitals may receive incentive payments under both the Medicare EHR Incentive Program and Medicaid EHR Incentive Program, provided that they meet all eligibility criteria. CMS provides the following guidance for hospitals with such dual-eligibility:

Hospitals that are eligible for EHR incentive payments under both Medicare and Medicaid should select "Both Medicare and Medicaid" during the registration process, even if they plan to apply only for a Medicaid EHR incentive payment by adopting, implementing, or upgrading certified EHR technology. Dually-eligible hospitals can then attest through CMS for their Medicare EHR incentive payment at a later date, if they so desire.

If you fall into this category, when registering for the program you must choose "Both Medicare and Medicaid." Please select your state from the drop-down menu on the registration screen. If your state's program has not yet launched at the time of your registration, your file will be placed into a pending status until your state's program is launched. That means you will not be able to complete your registration or receive an EHR incentive payment until your state's program launches. For a list of expected program launch dates, please visit the Medicaid State Information page.

Hospitals that register only for the Medicaid program (or only the Medicare program) will not be able to manually change their registration (i.e., change to "Both Medicare and Medicaid" or from one program to the other) after a payment is initiated and this may cause significant delays in receiving a Medicare EHR incentive payment."

(See Registration and Attestation at http://tinyurl.com/24f6ef7.)

In contrast, EPs who qualify for both EHR Incentive Programs can only choose one program when they register. Prior to 2015, an EP is permitted to switch to the other program one time, provided that the EP has already received at least one EHR incentive payment. EPs should be aware that an EP can receive incentives up to $44,000 per EP over a five-year period under the Medicare EHR Incentive Program, while an EP can receive incentives up to $63,750 per EP over six years under the Medicaid EHR Incentive Program.

Conclusion

Providers are encouraged by CMS to register for the Medicare and Medicaid EHR Incentive Programs as soon as possible. However, providers that are planning to participate in the Medicaid EHR Incentive Program and that are in States that have not yet opened registration may wish to wait until registration is available. Nevertheless, if the provider is an eligible hospital that is also planning to participate in the Medicare EHR Incentive Program in FY 2011 and otherwise ready to attest, it should consider registering and attesting once the attestation process is available (e.g., the attestation process is expected to be available in April 2011 for the Medicare EHR Incentive Program), and in any event no later than the November 30, 2011 deadline

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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