HITECH EMR Incentives/Meaningful Use Refresher

By Emilie J DiChristina, MBA for PracticeFirst

EMR Incentive Payments

Medicare will pay out HITECH incentive funds relative to your practice’s total annual allowable Medicare charges. During the provider’s first year in the program (2011 or 2012), Medicare will pay providers 75 percent of their total annual allowable Medicare charges with a ceiling of $18,000. Therefore, if a provider charges Medicare in excess of $24,000 in allowable charges, the maximum he will receive is $18,000 in EMR incentives.

Providers are required to attest that their chosen EMR meets the Meaningful Use requirements of HITECH (which shows that the EMR meets the ONC certification requirements). Providers may begin the attestation process after 90-days of Meaningful Use of a Certified EMR.

If they have not achieved $24,000 in allowable charges at the time of attestation, Medicare will hold off on disbursing the incentive payment until the provider has either achieved $24,000 in charges or March of the following year. This is done to maximize the total payment that providers will receive. Those providers who have achieved $24,000 in allowable charges at the time of attestation can expect to receive their incentive payment within four to eight weeks through the same method as they currently receive Medicare reimbursements.

Medicaid EMR incentive programs are administered by the states and therefore details surrounding these programs vary by state. Your biller will be able to assist you in meeting these requirements.

Definition of Meaningful Use (MU)

MU refers to a set of 15 criteria that medical providers must meet in order to prove that they are using their EMR as an effective tool in their practice. There are an added 10 criteria that are considered a la carte. These menu items are selected by the provider, (only 5 are needed) as further demonstration by the medical provider and his/her chosen EMR)

In total, each provider must complete 20 Meaningful Use criteria to qualify for stimulus payments during stage one of the EMR incentive program.

The criteria are established by the Office of the National Coordinator for Health Information Technology (ONC) after a suitable time for public input.

Meaningful Use (MU) Implementation Stages

MU will be measured in stages over five years. Each stage represents a level of adoption.

Stage One: Assess the major functionality of a certified EMR. To prove EMR certification, you will have to document a certain percentage of your patient visits, their diagnoses, and their prescriptions, immunizations and other relevant health information electronically. You also have to show that you use clinical support tools such as warnings and appointment or testing reminders. Finally you have to use your EMR to share patient information; and report quality measures and public health information.

Stage One – Mandatory (Core Set) Meaningful Use Criteria- All 15 Measures Required

  • Demographics (50%)
  • Vitals: BP and BMI (50%)
  • Problem list:
    ICD-9-CM or SNOMED (80%)
  • Active medication list (80%)
  • Medication allergies (80%)
  • Smoking status (50%)
  • Patient clinical visit summary
    (50% in 3 days)
  • Hospital discharge instructions (50%)
    – or –
    Patient with electronic copy (50% in 3 days)
  • e-Prescribing (40%)
  • CPOE (30% including a med)
  • Drug-drug and drug-allergy interactions
    (functionality enabled)
  • Exchange critical information
    (perform test)
  • Clinical decision support
    (one rule)
  • Security risk analysis
  • Report clinical quality
    (BP, BMI, Smoke, plus 3 others)


Stage One – Ala Carte Menu (Select 5 of 10

  • Drug-formulary checks (one report)
  • Structured lab results (40%)
  • Patients by conditions (one report)
  • Send patient-specific education (10%)
  • Medication reconciliation (50%)
  • Summary care record at transitions (50%)
  • Submit to immunization registries
    (perform at least one test)
  • Submit to syndromic surveillance
    (perform at least one test)
  • Send reminders to patients for preventative and follow-up care (20% > 65yrs. < 5yrs.)
  • Patient electronic access to labs, problems, meds and allergies (10% in 4 days)

Stage Two: In addition to having demonstrated and continuing to use all functions that prove certification from stage 1, the Final Rule places a significant emphasis on patient use of the EMR in that it requires:

  • More than 5% of all patients seen by the physician during the reporting period actually view, download, or transmit their available health information, and
  • More than 5% of patients seen send a secure message to the physician (containing health information, not just a request for an appointment).

CMS states that it is the responsibility of the physician to encourage patients by offering an attractive, patient-friendly portal.

The menu set of measures is intended to afford physicians some flexibility—there are 6 measures from which they must select 3. Part of the rationale for this structure is to make meaningful use more meaningful for specialists. Yet in Stage 2, specialists may find it difficult to find even three measures that will suit their specialty. For example, the syndromic surveillance reporting is still not working well, and allergist (for example)  may find that cancer registry reporting doesn’t apply. It is possible that a few providers will find no viable specialty registry to which to report so CMS.

Other specialties may find that they have to report on the family history measure and the electronic progress note as there is nothing else that may apply to them.

Stage Three: Expect to continue meeting MU criteria from stages 1 and 2 plus clinical decisions support for national high priority conditions, enrolling patients in a PHR, accessing comprehensive patient data and improving population health. Stage 3 criteria have not yet been defined in detail