EHR Meaningful Use Incentive Payment Regulations
February 5, 2014
The information below applies to organizations that maintain a contract with their Eligible Professionals (EPs) to bill and receive payment for the EP’s covered professional services.
A Wipfli client recently posed questions regarding its health system’s eligibility to be assigned incentive payments for Eligible Professionals (EPs) who had recently left the group. We’re sharing this information in case it may be beneficial to you too.
EPs who transfer to a different health system with a Certified EHR during a reporting period:
The incentive payment is tied to the individual provider,1 so they can only receive one incentive payment despite transferring systems. They either attest and receive the payment themselves or are allowed to elect one employer or entity with whom they have a contractual arrangement to assign payment via their TIN. 2 The regulations are not entirely clear whether the provider has to be under contract with an employer at the time of attestation, or just during the reporting period, in order to assign payment to that employer. This gets interesting when there are two employers with a claim to the payment, since CMS only allows for one to be designated. 2 It is possible that there may be room for negotiation with that provider and their new employer in order to share some of the incentive payment in exchange for using some of the original employer’s reporting period data.
EPs who transfer to a different health system without a Certified EHR (or out of practice) during a reporting period:
CMS has defined that a provider must have at least 50 percent of their patient encounters during the reporting period at a practice/location with a Certified EHR in order to be eligible.3 They have the option of only choosing the site(s) of practice with Certified EHR to report their meaningful use patient volume. 3 CMS has also stated that there is no minimum denominator or full-time employment status needed as a condition for eligibility.4 Therefore, the EP should be eligible to attest for incentive payments if at least 50 percent of their total patient encounters occurred in the original employer’s EHR, as long as the data from their original employer’s EHR exists for the entire reporting period.
As mentioned above, the regulations are unclear whether the provider has to be under contract with an employer at the time of attestation to assign payments to that employer via their TIN. It is possible that the payment would have to be assigned to the individual provider—in which case, the employer would want to negotiate acceptable terms for providing the reporting period data to the provider for attestation purposes.
EPs who die during a reporting period:
In order to register and attest for meaningful use, the EP must have an active NPI number.5 Since a provider’s NPI is deactivated upon their death, incentive payments cannot be made to an EP who has died before attestation is submitted.
An Introduction to the Medicare EHR Incentive Program for Eligible Professionals, CMS, Page 19
42 CFR § 495.10: Participation Requirements for EPs, Eligible Hospitals, and CAHs, Subpart F
Medicaid Questions on the CMS EHR Incentive Program Final Rule, Page 9, #30
EHR Incentive Programs Registration, Attestation, and PECOS Checklist, Page 2
Please contact your Wipfli Relationship Executive if you have questions.