Medicare EMR Incentives
This page outlines who is eligible under the Medicare program. A Medicare EP is defined as a doctor of medicine or osteopathy, doctor of dental surgery or dental medicine, doctor of podiatry, doctor of optometry or a chiropractor who is not hospital-based. A Medicare EP is considered hospital-based if 90% or more of the EP's services are performed in a hospital inpatient or emergency room setting.
What EMR Incentives are Available within the Medicare Program?
Under Medicare, physicians will be eligible for up to the following amount as soon as they can demonstrate Meaningful Use (beginning in 2011):
Year Physician Becomes a Meaningful User/Payment Per Year
| Meaningful Use Year | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | Total |
|---|---|---|---|---|---|---|---|
| 2011 | $18,000 | $12,000 | $8,000 | $4,000 | $2,000 | $ – | $44,000 |
| 2012 | $ – | $18,000 | $12,000 | $8,000 | $4,000 | $2,000 | $44,000 |
| 2013 | $ – | $ – | $15,000 | $12,000 | $8,000 | $4,000 | $39,000 |
| 2014 | $ – | $ – | $ – | $12,000 | $8,000 | $4,000 | $24,000 |
| 2015 | $ – | $ – | $ – | $ – | $ – | $ – | $0 |
NOTE: Physicians operating in a "provider shortage area" will be eligible for an incremental increase of 10% in their bonus payments.
How will the Physician Payment be Calculated under Medicare?
The Medicare payments will be calculated by multiplying the submitted allowable charges to Medicare by 75%, up to the capped amount for the year. So a physician aiming to collect the full incentive payment of $18,000 in 2011 will need to submit allowable charges of at least $24,000. Conversely, a physician submitting only $16,000 in allowables would collect $12,000 in 2011, even though the cap is higher.
What “Allowable Charges” Qualify Towards the Incentive Calculation?
These are based on what Medicare pays under the Medicare Physician Fee Schedule for covered professional services rendered by the Eligible Professional. Below is a list of services included in the Medicare Physician Fee Schedule.
- Physicians' services
- Services and supplies (including drugs and biologicals which are not usually self-administered by the patient) furnished as an incident to a physician's professional service
- Outpatient physical therapy services and outpatient occupational therapy services
- Antigens
- Prostate cancer screening tests
- Colorectal cancer screening tests
- Diabetes outpatient self-management training services
- An initial preventive physical examination
- Diagnostic X-ray tests and other diagnostic tests, but not including clinical diagnostic laboratory tests
- X-ray, radium, and radioactive isotope therapy, including materials and services of technicians
- Screening mammography
- Screening pap smear and screening pelvic exam
- Bone mass measurement