The US government offers Medicare and Medicaid EHR incentives to encourage the adoption of electronic health records. Eligible professionals must have or implement a certified EHR and use it in a meaningful way to qualify for funding. The maximum payment for Medicare is $44,000 USD, while Medicaid offers up to $63,750 USD over six years. Vendors can receive 85% of the total cost of the EHR, including related expenses. Pediatricians have a reduced minimum requirement and maximum payment under Medicaid.
The US government has initiated various programs to push hospitals and physicians to adopt electronic health records (EHRs) and move away from a paper-based record system. In 2009, the American Recovery and Reinvestment Act (ARRA) was signed into law allocating billions of US dollars for EHR incentives. Prior to the ARRA, a number of smaller EHR incentives, such as electronic prescribing (eRx), had been developed to make an early transition to electronic methods more attractive to physicians and facilities. Under ARRA, the two types of EHR incentives are the Medicare incentive program and the Medicaid incentive program.
Registration for Medicare and Medicaid EHR incentives began in January 2011. The US federal government implements the Medicare program, while the Medicaid program is state-implemented and voluntary, meaning it may not be available in all states. The latest year to enroll in EHR incentives is 2016.
To be eligible for funding under one of these programs, an Eligible Professional (EP) must have or implement a certified EHR and use the technology in a meaningful way. Significant use (MU) is defined by the Centers for Medicare and Medicaid services through a set of measures and criteria. Additional MU criteria may be imposed by individual states for Medicaid EHR incentives. An EP can only qualify for one program, but can change once before 2015.
EPs who enroll in the Medicare program must prove MU within the first year. The most a PE can receive while in the Medicare program is $44,000 US Dollars (USD). This includes a $3,000 USD bonus for providers who register and meet MU in 2011 or 2012. The annual payment amount is calculated as 75% of Medicare Part B bills. Providers in a shortage area of Healthcare Professionals (HPSA) receive an additional 10% incentive payment. Physicians, subsection (d) hospitals, and critical area hospitals (CAH) can apply for EHR incentives under Medicare.
First-year participation in the Medicaid program requires adoption, implementation, or upgrade to certified EHR technology only. The MU demonstration is required in the second year of participation. EPs can receive up to $63,750 USD over the course of six years. Children’s and acute care hospitals can apply for EHR incentives under Medicaid, but their payments will be based on a $2 million dollar basis, among other factors.
For a vendor, the payment is calculated as 85 percent of the total cost of the EHR, including related expenses such as training and implementation. In addition to physicians, there are five types of PE who are eligible for Medicaid EHR incentives, including medical assistance in specific cases. To qualify under the Medicaid provision, a PE must have at least 30 percent of his or her claims attributable to Medicaid. This minimum number is reduced to 20 percent and the maximum payment is reduced by a third for pediatricians.
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