By Dava Stewart
It is highly doubtful that any DC practicing in the United States does not know the basics of electronic health record reimbursements and incentives. Just understanding the basics, though, may leave you with some knowledge gaps, misunderstandings, or simply a few questions.
Often, it seems that HIPAA, audits, EHRs, ICD-9 and 10, and reimbursements all end up together in one big pile. Although each item is related, they are pretty different. Another possible area of confusion is the fact that “reimbursement” is a term that DCs and their office staffs use most often to discuss payments from insurance companies.
In the context of EHRs, reimbursements refer to the Medicare and Medicaid Electronic Health Records Incentives Programs. According to the Centers for Medicare and Medicaid Services (CMS) website:
“The Medicare and Medicaid Electronic Health Care Record (EHR) Incentive Programs provide incentive payments to eligible professionals, eligible hospitals, and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.”
The first important point for DCs to know is that they fall into the “eligible professionals” category, which means they can receive the incentives, often referred to as reimbursements. However, according to a CMS guide on the basics of the program, “It is important to note that the Medicaid EHR Incentive program is not a reimbursement program to purchasing or replacing an EHR.”
The second important thing to note is that these programs began in 2011, and they are structured so that first payments are reduced each year. In other words, those who began participating in the Medicare program in 2011 or 2012 could have received a maximum first payment of $18,000; those who receive a first payment in 2014 could receive a maximum $14,700. The program will end in 2016, so those eligible professionals who are late to join one of the programs will receive limited incentive payments.
A third point that is often somewhat muddled is that there are actually two, separate incentives programs: one run by Medicare at the federal level and those that are operated by Medicaid at the state level. Eligible professionals must choose one or the other. Although they are similar, there are some differences, so it’s a decision to be made carefully.
A final point of importance is that there are requirements. Since this is a program run by a department within the government, there is copious red tape. Forms must be completed properly, by strict deadlines, and following exact protocol. It is a good idea to read some of the materials the CMS created specifically for eligible professionals (as opposed to physicians or hospitals), as well as the booklet made especially for chiropractors.