November 29, 2012

Do You Intend to Avoid the Medicare EHR Claims “Payment Adjustments” (Penalties)?? I have an important alert for you.

I trust by now that my readers know that any entity, that is eligible for the Medicare EHR Incentive, that fails to be a meaningful user (MU) by 12/31/2014, will be subject to a payment reduction of 1% on ALL professional claims paid by Medicare. Continuing failure to be a MU’er in 2016 means a 2% reduction, and 2017 and thereafter means a 3% reduction.

The EHR Stage 2 final regs, released on 9/4/12 clarified when these meaningful use calculations must occur, and it may be earlier than some folks had been thinking. Generally, the entity’s status 2 years prior will determine if a penalty will apply. So:

As 2015 will be the 1st penalty year, one’s MU status in 2013 will serve as the determinate

When we consider the implications of this, it is important to remember that the Medicare incentive requires that, once you have achieved MU status, you must continue to meet MU criteria to receive the incentive in each of the 3 subsequent years.

Back to the implications:

• If you 1st achieved MU in 2011, you must do so in 2013 as well
• If you 1st achieved MU in 2012, you must do so in the following year as well
• If you are seeking your 1st year of MU in 2013, you can select any 90 day period, including the final quarter in the year, to achieve MU and avoid the penalty in 2015.

The feds have created a special provision on the Medicare payment penalties for entities who are making their 1st attempt at MU during the year just prior to the penalty year. Regarding the 2015 penalty year, you can avoid the 2015 penalty if you achieve your 1st year 90-day MU status (and complete your attestation reporting) prior to the final quarter of 2014.

• Because hospitals use the federal FY, in 2014, the achievement date will be July 3, 2014. This means their reporting window in 2014 would start no later than April 2, 2014

• Because the EPs use the calendar year, in 2014, the achievement date will be October 1, 2014. This means their reporting window in 2014 would start on July 3, 2014

If you are receiving the Medicaid EHR incentive from your state AND submit federal claims under Medicare for those program eligibles, your MU status under the Medicaid EHR incentive can affect your vulnerability for the Medicare payment penalty.

• If you achieved Medicaid A/I/U status in 2012, you were technically not yet a MU’er. So, your 1st year status as a Medicaid MU’er must be achieved in 2013 to avoid the penalty on your 2015 Medicare claims.

If you have been able to follow all of this (and this kind of thing generally takes more than one pass), you may be asking yourself why you cannot, as a Medicaid EHR incentive participant, be allowed to have the early part of 2014 to achieve your 1st year Medicaid MU Status and avoid the Medicare 2015 payment penalty. I have the same question. Once I get some clarification, I will produce another blog post.

Comments anyone???

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