September 22, 2023

Epic Law

The Law Folks

Non-Physician Providers Not Considered EPs in Medicare EHR Incentive Program

CMS reps want to ensure healthcare providers optimize your chances of collecting from the EHR incentive program, which could net an eligible professional (EP) $44,000 over a period of five years.

According to a February 21 CMS-sponsored Physicians, Nurses, and Allied Health Professionals Open Door Forum, CMS’ proposal pertaining to the incentive program informs who can participate and what type of EHR you will have to use.

What you should know…

Now that the agency has proposed a definition of who qualifies as a ‘meaningful user’, CMS has started making use of the acronym “MU” to refer to meaningful use, stressed Charlotte Newman, director of the national Medicare training program with CMS’s Office of External Affairs, during the call.

EHR system shopping alert: At this point, providers may want to hold off on shopping for EHR.

Elizabeth Holland, the HITECH team lead in the office of E-Health Standards and Services at CMS, said during the call, “In order to get an incentive for your meaningful use of a certified EHR, there is requirement for EHRs that are certified.”

Holland informed that as of today, there’re no EHRs that have been certified for the CMS incentive program. “We’ll be able to provide you with a list of those EHRs at a later date, which is yet to be determined.”

One caller said that her practice is keen to buy a certified EHR system to get it into place, and asked when she might have access to the standards that the EHR vendors must meet.

The CMS representative pointed out that the standards are available for viewing in the interim final rule that was issued on January. 13, 2010, but that the standards published are still under comment period.

Who’s an EP?

According to Holland, you are considered a Medicare EP if you fit into one of these categories:

• Doctor of medicine or osteopathy

• Doctor of dental surgery/dental medicine

• Doctor of podiatric medicine

• Doctor of optometry

• Chiropractor

Although Medicaid incentive payments are there for some other providers (be it nurse practitioners and certified nurse midwives who meet all of the criteria), those providers are not considered EPs under Medicare’s incentive program.

Holland said, “One of the most controversial provisions in this notice of proposed rulemaking is the hospital-based eligible professionals one.” “Fundamentally in the proposal we determined the definition for hospital-based. These EPs will not qualify for Medicare EHR incentive payments and most will not meet the criteria for Medicaid also.”

CMS defined hospital-based EPs as those who provide 90 percent or more of their services in a hospital setting “and that is determined by the place of service codes on the claim,” said Holland.

Privacy: Providers worried about confidentiality should note that information included in the EHRs is subject to the same HIPAA requirements as other PHI, indicated Holland.

Non-par practices: Physician practices that are considered non-participating in Medicare still face the same criteria and eligibility factors for the incentive program as those that do participate.

The CMS rep responded, “It is based on your allowed charges to Medicare; it is not influenced by whether you participate in Medicare or not.”