Health Information Technology FAQs

Q1: Am I an eligible provider?

A: EPs for the Medicare health IT incentive program include doctors of medicine who are not hospital-based providers. Professionals providing more than 90% of services in the inpatient or emergency room setting are considered “hospital-based providers.”

EPs for the Medicaid health IT incentive program include professionals who have a minimum of 30% Medicaid patient volume. (Note: This summary focuses on the Medicare incentive program)

Note: This summary focuses on the Medicare incentive program, however, the Medicaid “meaningful use” incentive program has higher incentive payments.  Please check to see whether you qualify for the Medicaid program before registering for the Medicare program.

All EPs must:

  • Register via the Incentive Program website.
    Please click here to register.
  • Be enrolled in Medicare fee-for-service, Medicare Advantage, or Medicaid
  • Have a National Provider Number (NPI)
  • Use certified electronic health record technology
  • All Medicare providers must be enrolled in PECOS
    Register as soon as possible. EPs may register before having a health IT system installed.

Items for registration:

  • Name of EP, Business Address, and Business Phone
  • National Provider Identifier (NPI) Number
  • National Plan and Provider Enumeration System (NPPES) ID and Password
  • Taxpayer Identification Number (TIN)
  • Medicare or Medicaid Program Selection (EPs may only switch programs once)
  • State selection (for Medicaid incentive program)

Q2: Am I using “certified” electronic health record technology?

A: For a complete list of certified health IT products, please visit:
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Certification.html

It is worth noting that simply upgrading the functionality of your current electronic health record software does not automatically qualify your EMR as a “certified” electronic health record. All products, even modules, must be approved by an HHS certification body.

ACG recommends that your EMR provider present you with a certificate confirming that the EMR product is approved for the “meaningful use” incentive program.

Q3: How much are the incentive payments?

A: The Medicare incentive program payments include 1 payment per year and are capped at $44,000 per physician over the life of the program. Providers must be registered in the program by 2014 to receive incentive payments and the last payment year is 2016.

CY 2011 CY 2012 CY 2013 CY 2014 CY 2015
Payment Year 2011 $18,000
Payment Year 2012 $12,000 $18,000
Payment Year 2013 $8,000 $12,000 $15,000
Payment Year 2014 $4,000 $8,000 $12,000 $12,000
Payment Year 2015 $2,000 $4,000 $8,000 $8,000 $0
Payment Year 2016 $2,000 $4,000 $4,000 $0
Total $44,000 $44,000 $39,000 $24,000 $0

There is an additional bonus for physicians practicing in a Health Professional Shortage Area. Please click on the following link to find out whether you practice in a designated Health Professional Shortage Area: http://hpsafind.hrsa.gov/HPSASearch.aspx.

Q4: How do I demonstrate “meaningful use”?

A: To demonstrate “meaningful use,” EPs need to show CMS they are using certified health IT in the following ways:

  • Fifteen “core set” health IT measures.
  • Five “menu set” health IT measures.

For a list of these fifteen “core set” and ten “menu set” measures, please click on the following link:
Core and Menu Set Measures – Chart

To view the Core Measures Guide and Specification Sheets, please click here:
Core and Menu Set Spec Sheets

Each specification sheet covers a single eligible professional core or menu set objective in detail, including information on:

  • Meeting the measure for each objective
  • How to calculate the numerator and denominator for each objective
  • How to qualify for an exclusion to an objective
  • In-depth definitions of terms that clarify objective requirements
  • Requirements for attesting to each measure

To demonstrate “meaningful use,” EPs must also report:

  • Six total clinical quality measures (3 “core/alternative core” quality measures and 3 out of 38 “menu set” quality measures)

Core & Alternative Core Measures:

NQF & PQRI Number Quality Measure
NQF 0013 Hypertension: Blood Pressure Management
NQF 0028 Preventive Care and Screening Measure Pair: tobacco use and tobacco cessation intervention
NQF 0421
PQRI 128
Adult Weight Screening and Follow-up
Alternative Core Measures
NQF 0024 Weight Assessment and Counseling for Children and Adolescents
NQF 0041
PQRI 110
Preventive Care and Screening: Influenza and patients ≥ 50 years old
NQF 0038 Childhood Immunization Status

For a list of these clinical quality measures, please click on the following link:
Clinical Quality Measures – Chart

For guidance on how to report these clinical quality measures, please click here:
Clinical Quality Measure Assistance

EPs seeking to report clinical quality measures to CMS will attest to the aggregate numerator, denominator, and exclusion data.

If one or more of the core measures is not applicable to the EP, then the provider is required to use one or more of the 3 ‘alternative core’ measures provided by CMS. However, exclusions do apply if the EP attests that these measures are not applicable to the EP.

Additionally, providers will be exempt from reporting the additional menu set measures if an EP attests that all other clinical quality measures do not apply to the provider (have zero as the dominator).

CMS notes that the clinical quality measure requirements are simply reporting requirements and not performance requirements. This allows eligible providers to report quality measures with a zero in the denominator and still be considered to have met the clinical quality measures submission requirement.

Q5: Where do I go for more assistance?