Think That You Are Ineligible For Stimulus Funds??? Check Here!

As the timing ticks away for practices to select, implement and meaningfully use a certified EHR so as to take advantage of the maximum ARRA EHR stimulus rebate, perhaps the most pressing question being asked by providers is whether they are even eligible for ARRA EHR stimulus funds???

Every provider that accepts Medicare qualifies for some portion of stimulus funds.  The percentage of a provider’s Medicare patient base is not a factor in determining eligibility for the Medicare stimulus finds.  Rather, it is the Medicare allowable charges that is key.  As long as a providerr has one allowable charge, then he/she is eligible for the stimulus funds.  Then the question becomes how much of the annual stimulus rebate is he/she entitled to receive.  There is a simple formula for determining this:

Total annual Medicare Allowable Charges by provider divided by $24,000

That formula will result in the percentage of Medicare stimulus funds a provider is entitled to receive, up to 100%, which represents the the maximum percentage of the annual stimulus funds that can be earned during a particular year.

For example: 

• if a provider’s allowable charges total $12,000 in his/her first year meaningfully using a certified EHR, then the physician qualifies for 50% of the annual stimulus funding ($12,000/$24,000).  In 2011 the funding is $18,000, so that provider would receive $9,000 of ARRA stimulus funds   
• if a provider’s allowable charges total $24,000 in his/her first year meaningfully using a certified EHR, then the physician qualifies for 100% of the annual stimulus funding ($24,000/$24,000).  In 2011 the funding is $18,000, so that provider would receive $18,000 of ARRA stimulus funds

Essentially, any provider whose Medicare allowable charges meet or exceed $24,000 will receive 100% of that year’s ARRA rebate incentive (up to a maximum total of $44,00 throughout the life of the program).  This figure can also be arrived at by multiplying total Medicare allowable charges by 75%…  ARRA rebate amount is the product of that equation or 18,000 – whichever is less. 

NOTE TO MEDICAID PROVIDERS:  If you have a measurable Medicaid population — at least 30% of your patient population (or 20% if a pediatrician) — then the Medicaid EHR Incentive Program, which is offered and administered voluntarily by states and territories, may be of interest as an alternative to the Medicare program (must choose between the two programs).  To qualify for Medicaid incentive payments, Medicaid eligible professionals must adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in the first year of participation, and successfully demonstrate meaningful use in subsequent participation years, just like in the Medicare program.  However, under the Medicaid program, participants can receive up to $63,750 over 6 years (as opposed to $44,000 over 5 years):

Check with your state’s Medicaid program to see if the rebate program has been implemented yet, as it is a state-by-state roll-out.

Government Incentivizes EMR Adoption

Reposted from www.medicbilling.com, October 2009

On February 17, 2009, the American Recovery and Reinvestment Act (ARRA) was signed into law, committing $19.2 billion to healthcare information technology (HIT) to promote the use of HIT for all providers of healthcare. A whopping $17.2 billion has been allocated as incentive payments to eligible healthcare professionals for EMR adoption. More specifically, providers using a certified EMR will be eligible for substantial government cash incentives in the years 2011 through 2014. While the law does not yet specify what constitutes a “certified” EMR, industry leaders agree that CCHIT will likely be selected as the standard. Providers who have not adopted a certified EMR by 2015 may be penalized.

As the chart below reflects, those providers adopting a certified EMR system in 2011 & 2012 will receive the greatest benefit, for they will be eligible for incentive payment for 5 years and at a higher rate.

Feel free to contact M.E.D.I.C., Inc. if you would like to discuss EMR options and issues as you prepare to foray into this new technology!

CMS Delays PECOS Phase II Implementation Date

CMS has recently issued a statement that it will NOT implement Phase 2 of PECOS on July 5^th, as was originally published (point of reference:  during Phase I, which is currently underway, claims will have an appended warning when the ordering/referring proivider is not enrolled in PECOS; during Phase 2, which has yet to begin, all claims processed with an ordering/referring provider who is not enrolled in PECOS will be denied…  for more information on what PECOS is, see post published June 8, 2010):

“It has come to CMS’ attention that there was an editorial oversight in the OIG Compendium of Unimplemented Recommendations (March 2011 Edition). The OIG report states that the CMS will delay the implementation of Phase 2 of Change Request (CR) 6417 and CR until Tuesday, July 5, 2011.  This is incorrect. 

 CMS has not yet determined when it will begin to apply the ordering/referring provider claim edit to ordering/referring providers that do not have a record in the Provider Enrollment, Chain, and Ownership System (PECOS).  As previously stated, CMS will give providers ample notice before the ordering/referring provider claim edit is applied.  Recent revisions to CRs #6417 and #6421 require MACs to delay rejecting claims until receiving further direction from CMS.”  (emphasis added)

So, the net result is that parties to whom patients are ordered/refered will continue to receive EOB warnings regarding the PECOS status of the referring provider, but will be paid.  For now. 

When will this change?  I have no idea, so it would be advisable for all providers who have not enrolled in PECOS to date to do so as soon as practicable.  Anyone needing assistance in a) checking to see whether they are currently enrolled in PECOS, or b) enrolling in PECOS can contact M.E.D.I.C., Inc. (lsneathern@medicbilling.com) — we are happy to assist! 

CMS Lifts Hold On Claims Processing

According to the CMS web site:

On March 2, 2010, President Obama signed into law the “Temporary Extension Act of 2010.”  Among other things, this law extends through March 31, 2010, the zero percent update to the Medicare Physician Fee Schedule that was in effect for claims with dates of service January 1, 2010, through February 28, 2010.  Consequently, effective immediately, claims with dates of service March 1 and later which were being held by Medicare contractors will be released for processing and payment.  Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).

In addition, the new law extends through March 31, 2010, the exception process for therapy claims reaching the annual cap, retroactive to January 1, 2010.  Affected providers may submit claims for exceptions to the annual therapy caps, with dates of service January 1 through March 31, 2010, using the KX modifier, following the pre-January 1, 2010, requirements for therapy cap exceptions.