Frequently Asked Questions (FAQs) – Medicaid EHR Incentive Program

Q1. Does The Gap Group provide certified EHR technology to provider practices?
A1. No, The Gap Group does not provide Certified EHR Technology, but they can facilitate the vendor selection process and provide an evaluation of the Certified EHR Technology that you are considering.

Q2: How do I know what EHR system is a CMS Certified EHR Technology?
A2: CMS has a list of approved 2014 Certified EHR Technology vendors that meet the requirements for attesting for Meaningful Use. The Gap Group can facilitate the vendor selection process and provide an evaluation of the Certified EHR Technology that you are considering.

Q3: I want to attest for Meaningful Use, but what if I can’t afford to implement an EHR system?
A3: The Gap Group can help you to identify some cost effective Certified EHR technology options and complete a free cost analysis that takes into consideration your return on investment for implementing an EHR system and attesting for Meaningful Use (receiving incentive payments and/or avoiding Medicare reimbursement penalties).

Q4. If I don’t see any Medicare patients and I’m not attesting for Meaningful Use, will I receive a penalty on my Medicare reimbursement?A4. No, you will not receive a penalty on Medicare reimbursement if you do not see any Medicare patients. However, if you should begin seeing Medicare patients you will begin incurring the penalties on Medicare reimbursement if you do not attest for Meaningful Use.

Q5. If I don’t qualify to participate in the EHR Medicaid Incentive Program because I don’t have 30% Medicaid patient volume (20% for pediatricians), will I still receive the penalty on my Medicare reimbursement?
A5. Yes, you will receive the penalty on Medicare reimbursement if do not attest for Meaningful Use. The only scenario that you would not be subject to the penalty is if you don’t see any Medicare patients.

Q6. If I am a pediatrician and qualify to participate in the EHR Medicaid Incentive Program by having 20% of Medicaid patient volume, will I qualify to receive the maximum incentive of $63,750?
A6. No, if you are a pediatrician with 20-29% Medicaid patient volume, then you will qualify to receive 2/3 of the maximum incentive of $42,502. The 20% is the minimum threshold for a pediatrician to be eligible to participate in the Medicaid EHR Incentive Program. If you have 30% Medicaid patient volume, then you will receive the maximum incentive of $63,750.

Q7: I don’t how to calculate the percentage of Medicaid patient volume that my practice has to determine if I am eligible to participate in the Medicaid EHR Incentive Program. Can The Gap Group help me determine if I am eligible to participate?
A7: Yes, The Gap Group can review your patient volume to determine whether you have the 30% Medicaid patient volume (20% for pediatricians) to participate in the Medicaid EHR Incentive Program. If you meet the eligibility requirements, The Gap Group will provide a free cost and benefit analysis of implementing a Certified EHR Technology, receiving incentive payments and determine any penalties to Medicare reimbursement, if applicable.

Q8: What time period is used to calculate my Medicaid patient volume to determine my eligibility to participate in the Medicaid EHR Incentive Program?
A8: CMS requires that providers calculate Medicaid patient volume from any 90-day period in the preceding calendar year.

Q9: If I am currently participating in the EHR Medicare Incentive Payment Program, can I participate in the EHR Medicaid Incentive Program?
A9: No, as provider you can only participate in one EHR Incentive Program.

Q10: What is the last year that I can begin participating in the Medicaid EHR Incentive Program?
A10: The last year to begin participation and receive incentive payments is 2016.

Q11: Is the Medicaid EHR Incentive Program operated by CMS?
A11: No, unlike the Medicare EHR Incentive Program which is operated by CMS, the Medicaid EHR Incentive Program is operated by each state’s Medicaid Agency.

Q12: How do I know if I will receive a penalty on my Medicare reimbursement in 2015?
A12: If you did not attest for Meaningful Use in 2013 and you have Medicare patients, then you will receive the 1% penalty to Medicare reimbursement in 2015. If you did not attest again in 2014, then the penalty increases to 2% in 2016. So, not attesting in 2015 would be a 3% penalty in 2017, 4% in 2018 and 5% in 2019. The Gap Group will provide a free cost and benefit analysis of implementing a Certified EHR Technology, receiving incentive payments and determine any penalties to Medicare reimbursement.

Q13: What is Meaningful Use?
A13:  Meaningful Use is the demonstration of eligible providers that they are “meaningfully using” certified EHR/EMR technology to improve patient care by meeting certain thresholds on specific objectives and clinical quality measures. CMS has established 3 stages of Meaningful Use objectives, with each stage increasing in requirements. The Medicare and Medicaid EHR Incentive Programs were created to provide financial incentives for participating providers meeting Meaningful Use.

Acronyms

CMS = Centers for Medicare and Medicaid Services

EHR = Electronic Health Record

EMR = Electronic Medical Record