Saturday, February 25, 2012

compare Medicare and Medicaid EHR program

Notable Differences between the Medicare and Medicaid EHR Incentive Programs

Medicare                                
  • Federal Government will implement (will be an option nationally)
  • Payment reduction begin in 2015 for providers that do not demonstrate Meaningful Use

  • Must demonstrate MU in year 1
  • Maximum incentive is $44,000 for EPs (10% bonus for EPs in HPSAs)
  • Meaningful Use definition is common for Medicare
  • Last year a provider may initiate program is 2014; Last year to register is 2016; Payment adjustments begin in 2015
  • Only physicians, subsection (d) hospitals and CAHsVoluntary for States to implement (may not be an option in every state)
Medicaid
  • Voluntary for States to implement (may not be an option in every state)

  • No Medicaid payment reductions
  • A/I/U option for 1st participation year
  • Maximum incentive is $63,750 for EPs
  • States can adopt certain additional requirements for Meaningful Use
  • Last year a provider may initiate program is 2016; Last year to register is 2016
  • 5 types of Eps, acute care hospitals (including CAHs) and children hospitals
Acronym Translation

A/I/U – Adopt, Implement or Upgrade

CAH – Critical Access Hospital

EHR – Electronic Health Record

EP – Eligible Professional

HPSA – Health Professional Shortage Area
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download