EHR Incentive Program Checklists

May 23, 2011

The Medicare and Medicaid EHR Incentive Programs checklists will show you the steps to take to receive your incentive payments, but first: EHR Incentive

  1. Find out if you are eligible for either the Medicare or Medicaid EHR Incentive Programs.
    • Professionals and hospitals can visit the Eligibility page to check eligibility.
  2. Are you a professional eligible for both programs? If so, you must choose a program and follow the rest of the relevant checklist below.

Not sure which program to choose? Compare “Notable Differences between the Medicare and Medicaid EHR Incentive Programs” .

Medicare EHR Incentive Program Checklist

If you’re an eligible professional, become a meaningful user of certified electronic health records to qualify for incentive payments of up to $44,000 from Medicare. Here’s how to qualify:

  • Make sure you’re eligible for the Medicare EHR Incentive Program. View eligibility guidelines at our Eligibility page.
  • Also eligible for the Medicaid EHR Incentive Program? You can receive higher incentive payments, up to $63,750, through the Medicaid EHR Incentive Program. See the Medicaid checklist.
  • Get registered. Registration is now open to eligible professionals. Visit the Registration page for more details.

Note: Register as soon as possible. You can register before having a system installed.

  • Use certified EHR technology. To receive incentive payments, make sure the EHR technology you’re using or are considering buying has been certified by the Office of the National Coordinator for Health Information Technology. Visit our Certified EHR Technology page for details.
  • Be a Meaningful User. You have to successfully demonstrate “meaningful use” for a consecutive 90-day period in your first year of participation (and for a full year in each subsequent years) to receive EHR incentive payments. Visit our Meaningful Use page to learn about meaningful use objectives and measures.
  • Attest for incentive payments. To get your EHR incentive payment, you must attest (legally state) through Medicare’s secure Web site that you’ve demonstrated “meaningful use” with certified EHR technology. You can now get to our secure Attestation Web site through a link at our Attestation page.

Medicaid EHR Incentive Program Checklist

If you’re an eligible professional, in your first year of participation you may adopt, implement or upgrade or become a meaningful user of certified electronic health records to qualify for incentive payments of up to $63,750 from Medicaid. Here’s how to qualify:

  • Make sure you’re eligible for the Medicaid EHR Incentive Program. View eligibility guidelines at our Eligibility page.
  • Also eligible for the Medicare EHR Incentive Program? Eligible professionals can receive up to $44,000 through the Medicare EHR Incentive Program. See the Medicare checklist.
  • Get registered. Visit the “Medicaid State Information” page to see if your state is participating in the Medicaid EHR Incentive Program.
  • If your state is already participating, register now for the Medicaid EHR Incentive Program.  Visit the Registration page for more details
  • If your state has not yet begun participating in the Medicaid EHR Incentive Program: you may wish to register now for the Medicare EHR Incentive Program, if you’re eligible for both programs. See the Medicare checklist.

Note: Register as soon as possible. You can register before having a system installed.

  • Use certified EHR technology. To receive incentive payments, make sure the EHR technology you’re using or are considering buying has been certified by the Office of the National Coordinator for Health Information Technology. Visit our Certified EHR Technology page for details.
  • Get qualified. To receive EHR incentive payments in the first year under the Medicaid EHR Incentive Program, you must do at least one of the following:
    • Adopt certified EHR technology; or
    • Implement certified EHR technology you have already purchased; or
    • Upgrade your current EHR technology to the newly certified version; or
    • Demonstrate “meaningful use” of certified EHR technology for a 90-day period. Visit your state’s Medicaid agency Web site or our Meaningful Use page to learn about meaningful use objectives and measures.
  • Attest for incentive payments. To get your EHR incentive payment, you must attest (legally state) through your state’s Medicaid agency Web site that you’ve met all of the eligibility criteria, including having adopted, implemented, upgraded or meaningfully used certified EHR technology. Visit your state’s Medicaid agency Web site for more information.

Source: CMS


2011 Medicare e-Prescribing Incentives and 2012-2013 Medicare e-Prescribing Penalties

May 16, 2011

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized a new and separate federal incentive program for eligible professionals (EPs) who are successful electronic prescribers.  This incentive is in addition to the electronic health record (EHR) program and the Physician Quality Reporting System (PQRS) program.

Providers could qualify for multiple incentive programs.  However, within the same year, providers could only qualify for the Medicare EHR incentive program OR the Medicare e-Prescribing incentive  program, not both.  Therefore, it would be advisable to participate for the e-Prescribing incentive program for 2011 and then apply for the Medicare EHR incentive program in the following year.  If the provider chooses to participate in the MediCaid EHR incentive program and the Medicare e-Prescribing incentive program in the same year, the qualified provider is eligible to receive incentives under BOTH programs.

Benefits of e-Prescribing

First, e-Prescribing is offered as a way to prevent medication errors that arise due to difficulties in reading or understanding handwritten prescriptions.  In addition, e-Prescribing could reduce adverse drug events (ADEs) by making information such as drug interactions and contraindications available to prescribers at the time they are preparing a prescription.  Finally, e-Prescribing may reduce patients’ out-of-pocket costs by placing formulary, coverage and copayment information at prescribers’ fingertips.

Reporting Period

The reporting period for the 2011 e-Prescribing incentive program will be for the entire 2011 calendar year (January 1, 2011 through December 31, 2011)

Incentive Amount

The 2011 Medicare e-Prescribing incentive program provides an incentive payment to eligible physicians who successfully e-Prescribe medications in 2011 equal to 1% of their total Medicare payments for the year.  For example, if you bill Medicare $100,000 in allowable charges in 2011 and successfully report on e-Prescribing, you would receive $1,000.

Year     Incentive Amount

  • 2011     1.0%
  • 2012     1.0%
  • 2013     0.5%
  • 2014     0.0%

Note: Payment bonuses are made after the conclusion of the calendar year in which eligible physicians e-Prescribe for their Medicare patients, not as an up front payment.

Reporting Requirements

To participate in the 2011 e-Prescribing incentive program, individual eligible physicians may choose to report on their adoption and use of a qualified e-Prescribing measure, G code, G8553.

Sample Claim Form With G-Code

In order to receive incentive payments for e-Prescribing in 2011, eligible physicians must report the e-Prescribing G-code, G8553, at least 25 times on their claim forms. At least 10 of the 25 claims should be reported between January 1, 2011 through June 30, 2011 reporting period.


According to MIPPA, physicians who are eligible but choose not to participate in the 2012 or 2013 Medicare e-Prescribing incentive program, the following penalties would apply based on their allowable charges for the year:

Year     Penalty Amount

  • 2011     -0.0%
  • 2012     -1.0%
  • 2013     -1.5%
  • 2014     -2.0%

CMS is basing the 2012 penalties on e-Prescribing activity that occurs during January 1, 2011 through June 30, 2011, and the 2013 penalties on e-prescribing activity that occurs throughout 2011.  To avoid penalties in 2013, an eligible physician must e-Prescribe and report the e-Prescribing G-Code, G8553, at least 10 times for applicable office visits and services for the January 1, 2011 through June 30, 2011 reporting period on Medicare claim forms (report at least 25 times throughout 2011 to avoid penalties in 2013).

Exceptions to Penalty for non-Participation

The 2012 and 2013 e-Prescribing penalty will not apply to:

  • An eligible physician who has less than 100 claims for dates of service between January 1, 2011 through June 30, 2011.


  • An eligible who is not a physician, nurse practitioner or physician assistant as of June 30, 2011;
  • An eligible physician for whom office visits and other services listed in the CMS e-Prescribing measure specifications represent less than 10% of their allowed charges in the first six months of 2011.


Accountable Care Organizations (ACOs)

April 29, 2011
Accountable Care Organizations (ACOs)

ACO - Healthcare Provider Network

On March 31, 2011, the Centers for Medicare & Medicaid services (CMS) proposed new rules under the Affordable Care Act to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs).  CMS has created incentives for the ACOs to coordinate patient care across care settings – including doctors’ offices, hospitals, and long-term facilities.  The Medicare Shared Savings Programs will reward ACOs based on lowering costs of providing healthcare services while meeting performance standards on quality of care.  Patient and provider participation in an ACO is voluntary.

Who are included in an ACO?

  • ACO professionals (i.e., physicians and hospitals) in group practice arrangements,
  • Network of individual practices of ACO professionals,
  • Partnerships of joint ventures arrangements between hospitals and other ACO professionals,
  • Hospitals employing ACO professionals.

How could providers participate?

Providers can participate in Medicare’s Shared Savings Program, providers must form or join an Accountable Care Organization (ACO) and apply to CMS. If accepted, ACOs would serve at least 5,000 Medicare patients and agree to participate in the program for 3 years.  Providers would continue to receive payment under Original Medicare fee-for-service (FFS) rules.

As part of the participation criteria, ACOs must establish a governing body representing ACO providers of services, supplier, and Medicare beneficiaries.

How would the Shared Savings work?

Medicare would continue to pay individual providers and suppliers as it currently does under the Original Medicare fee-for-service payment system.  In addition, CMS would develop a benchmark for each ACO against which its performance is measured to assess whether an ACO qualifies to receive shared savings, or be held accountable for losses.  The benchmark would be an estimate of what the total Medicare fee-for-service Parts A and B expenditures for ACO beneficiaries would otherwise have been in the absence of the ACO.

What are proposed quality measurements that CMS would be using?

CMS has proposed to measure quality of care by the ACOs using nationally recognized measures in 5 key areas:

  1. Patient experience;
  2. Care coordination;
  3. Patient safety;
  4. Preventive health; and
  5. At-risk population/frail elderly health.

Effective date of ACOs?

January 1, 2012.

ICD-10 / Version 5010 Timeline

April 27, 2011


Click the link for a copy of the timeline in .PDF: ICD-10 – TimeLine

ICD-10-CM: Benefits and Enhancement to ICD-9-CM

April 27, 2011

ICD10_BenefitsOn or after October 1, 2013, the current diagnosis code sets (ICD-9-CM) will be replaced with the new code – ICD-10-CM.  This article discusses the benefits of ICD-10-CM, similarities and differences between the two coding systems, and new features and and additional changes that can be found in ICD-10-CM.

Benefits of ICD-10-CM:

ICD-9-CM is 30 years old, has outdated and obsolete terminology that produce inaccurate and limited data, and is inconsistent with the current medical practice. ICD-10-CM incorporates much greater clinical detail and specificity than ICD-9-CM.  ICD-10-CM:

  • Incorporates much greater specificity and clinical information, which results in:
    • Improved ability to measure health care services;
    • Increased sensitivity when refining grouping and reimbursement methodologies;
    • Enhances ability to conduct public health surveillance; and
    • Decreased need to include supporting documentation with claims;
  • Includes updated medical terminology that is consistent with the current medical practice;
  • Provides codes to allow comparison of mortality and morbidity data; and
  • Provides better data for:
    • Measuring care furnished to patients;
    • Designing payment systems;
    • Processing claims;
    • Making clinical decisions;
    • Tracking public health;
    • Identifying fraud and abuse; and
    • Conducting research.

New Features Found in ICD-10-CM:

  • Laterality (left, right, bilateral)
  • Combination codes for certain conditions and common associated symptoms and manifestations
  • Combination codes for poisonings and their associated external cause
  • Obstetric codes identify trimester instead of episode of care
  • Character “x” is used as a 5th character placeholder in certain 6 character codes to allow for future expansion and to fill in other empty characters when a code that is less than 6 characters in length requires a 7th character
  • Two types of Excludes notes
    • Excludes 1 – indicates that the code excluded should never be used with the code where the note is located
    • Excludes 2 – indicates that the patient may have combination of conditions and both codes could be used
  • Inclusion of clinical concepts that do not exists in ICD-9-CM e.g. underdosing, blood type, blood alcohol level
  • Expansion of codes e.g. injuries, diabetes, substance abuse, postoperative complications
  • Codes for postoperative complications have been expanded and a distinctions made between intraoperative complications and postprocedural disorders

Additional Changes Found in ICD-10-CM:

  • Injuries are grouped by anatomical site rather than by type of injury;
  • Codes and categories have reorganize;
  • New code definitions; and
  • The current “V” codes (Factors influencing health status and contact with health services) and “E” codes (External causes of injury and poisoning) are incorporated into the main classification rather than separated into supplemental sections.

ICD-10 is Coming! Are you ready?

April 22, 2011

ICD-10The compliance date for implementation of the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding system (ICD-10-CM/PCS) is October 1, 2013.  There are two parts to the ICD-10-CM/PCS:

  • ICD-10-CM (Diagnosis Codes) – The diagnosis classification system developed by the by the Centers for Disease Control (CDC) and Prevention for us in all the U.S. health care treatment settings.
    • 3-7 digits
    • Digit 1 is alpha
    • Digit 2 is numeric
    • Digits 3-7 are alpha or numeric (alpha digits are not case sensitive)
        • Examples:
          • A78 – Q fever
          • A69.21 – Meningitis due to Lyme disease
          • S52.131a – Displace fracture of neck of right radius, initial encounter for closed fracture
  • ICD-10-PCS (Procedural Codes) – The procedure classification system developed by CDC for Medicare & Medicaid Services (CMS) for use in the U.S. for inpatient hospital settings ONLY.
    • 7 digits
    • Each digit is either alpha or numeric (alpha digits are not case sensitive and letters 0 and I are not used to avoid confusion with numbers 0 and 1)
        • Examples:
          • 0FB03ZX – Excision of liver, percutaneous approach, diagnostic
          • 0DQ10ZZ – Repair upper esophagus, open approach

Note: Physicians, outpatient facilities , and hospital outpatient departments should continue to use CPT codes for Medicare fee-for-service claims.

ICD-10-CM/PCS provides significant improvements through greater information and the ability to expand in order to capture additional advancements in clinical medicine.  A number of other countries have already moved to ICD-90, including:

  • United Kingdom (1995);
  • France (1997);
  • Australia (1998);
  • Germany (2000); and
  • Canada (2001).

Click the link to see the ICD10 compliance timeline: ICD10 Compliance Timeline

Medicare and Medi-Cal EHR Incentive

March 21, 2011

If you are an Eligible Professional (EP) and have already purchased a certified EHR system, then your next step is to go through registration.

First, you would need to register at Medicare for your federal incentive. If you are planning to apply for the Medi-Cal incentive, you would still need to first register with Medicare and then, sometime in April 2011, register with the state.

Watch the following video for more information about registering with Medicare:

Meaningful Yoose

March 14, 2011

Here’s what eligible providers need to know about getting incentive dollars from CMS for the meaningful use of electronic health records in under 3 minutes. The American College of Medical Informatimusicology presents the Meaningful Yoose Rap, written and performed by Dr. Ross D. Martin, directed by Ishu Krishna. Shared under the Creative Commons Share-Alike, Attribution license.

CMS Releases Important Update on PECOS

February 17, 2011

The Centers for Medicare & Medicaid Services (CMS) previously announced that, beginning January 3, 2011, if certain Part B billed items and services require an ordering/referring provider and the ordering/referring provider is not in the claim, is not of a profession that is permitted to order/refer, or does not have an enrollment record in the Medicare Provider Enrollment, Chain and Ownership System (PECOS), the claim will not be paid. The automated edits will not be turned on effective January 3, 2011.

CMS has stated that it is working diligently to resolve their enrollment backlogs and other system issues and will provide ample advanced notice to the provider and beneficiary communities before CMS begins any automatic nonpayment actions.

CMS urged physicians or other eligible professionals not currently enrolled in PECOS to enroll sooner rather than later, and outlined three ways that providers can verify their enrollment record in their system:

Physicians Using Social Media for Job Hunting

December 29, 2010

A significant proportion of health care job seekers, including physicians, are using some form of social media to look for work, although the results are modest compared with more established means, according to a survey released Dec. 14 by the San Diego staffing company AMN Healthcare Services.

Researchers analyzed questionnaires completed by 1,248 health care professionals, including 98 physicians.

Job Search Method Percent of Physician Applicants Interviewed for the Job Offered a Job
Social media 15% 5% 4%
Text message alerts 9% 4% 0%
Referrals 80% 54% 49%


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