CMS incentive programs

The Centers for Medicare & Medicaid Services (CMS) has initiated several programs providing eligible professionals with the opportunity to receive incentive payments for participation. The programs are voluntary, but with the eventual specter of “payment adjustments” for nonparticipants or those who fail to meet the programs’ requirements.

Medicare and Medicaid EHR Incentive Programs

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), part of the American Recovery and Reinvestment Act of 2009, Medicare and Medicaid incentive payments will be available to eligible professionals, eligible hospitals, and critical access hospitals (CAHs) when they adopt certified EHR technology and successfully demonstrate “meaningful use” of the technology in ways that improve quality, safety, and effectiveness of patient-centered care.

Under the EHR incentive programs, eligible professionals can receive as much as $44,000 over a five-year period through Medicare. For Medicaid, eligible professionals can receive as much as $63,750 over six years. Under both Medicare and Medicaid, eligible hospitals may receive millions of dollars for implementing and meaningfully using certified EHR technology.

Resources

The CMS official website for the Medicare and Medicaid EHR Incentive Programs provides the most up-to-date, detailed information.
http://www.cms.gov/EHRIncentivePrograms/

The Medicaid HIT Project is responsible for implementing and running the Medicaid EHR Incentive Program for eligible Oregon providers.
http://www.oregon.gov/DHS/mhit/incentive.shtml

Assistance is available from O-HITEC, Oregon’s Regional Extension Center (REC), to help providers become adept and meaningful users of electronic health records (EHRs).
http://o-hitec.org/

2011 Physician Quality Reporting System (PQRS), formerly Physician Quality Reporting Initiative (PQRI)

The Physician Quality Reporting System is voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs), and beginning with the 2010 Physician Quality Reporting System, group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries.

The Physician Quality Reporting System was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). 

CMS information about the PQRS program

Electronic Prescribing (eRx) Incentive Program

The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals and beginning with the 2010 eRx Incentive Program, group practices. Eligible professionals do not need to participate in PQRS to participate in the Electronic Prescribing (eRx) Incentive Program.
Beginning in 2012, eligible professionals who are not successful electronic prescribers may be subject to a payment adjustment on their Medicare Part B Physician Fee Schedule (PFS) covered professional services.

CMS information about the e-prescribing incentive program