Thursday, February 23, 2012

Medicaid EHR adopting, implementing or upgrading final rule

The Medicaid provisions of the final rule for Adopting, implementing, or  upgrading certified EHR technology and Demonstrating meaningful use of EHR technology


Adopting, Implementing, or Upgrading Certified EHR Technology

The final rule:

  •  Discusses that providers in their first year of participation in the Medicaid incentive payment program may demonstrate that they have adopted (e.g. acquired, purchased or secured access to), implemented (e.g. installed or commenced utilization of ) or upgraded to   certified EHR technology in order to qualify for an incentive payment;

  • Describes the methodology for demonstrating adoption, implementation and upgrading, and for states to monitor these activities;


 Demonstrating Meaningful Use of Certified EHR Technology
 The final rule:

  •  Finalizes a shared minimum definition of meaningful use with Medicare. However, CMS will allow states to request CMS approval to require that four public health related measures be core instead of menu measures for Medicaid providers and to specify some of the destination and transmission details;

  • Discusses how clinical quality measures reporting will be submitted to the states by Medicaid providers, such as via attestation or electronically via EHRs.

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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