CMS Health IT Incentives: 52 Frequently Asked Questions

Please be advised that these FAQs were generated and excerpted from a database that is updated frequently by the Centers for Medicare and Medicaid Services (CMS).
For the most up-to-date official CMS information, please visit http://questions.cms.hhs.gov or click here to get the latest CMS FAQs on the Electronic Health Records Incentive Program. To get the latest answer on a specific question below, go to either of the links in the previous sentence, use the search box labelled “Find the answer to  your question” located just above the FAQs, type in the four digits only of the “Answer #”, and click “Search”. The general CMS search box does not work the same way.

The url to get the complete list of CMS FAQs on EHR Incentive Program:
http://questions.cms.hhs.gov/app/answers/list/p/21,26,1058
Accessed Date: 8/19/2010

Most of the EHR Incentive FAQs on CMS site included either or both of these links: 
For more information, please visit the Office of the National Coordinator’s website at http://healthit.hhs.gov/certification.
For more information about the Medicare and Medicaid EHR Incentive Program, please visit:  http://www.cms.gov/EHRIncentivePrograms

FAQs on EHR Incentive Program
Question #9814: How will eligible professionals (EPs) and eligible hospitals apply for incentives under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program?

Answer: Information on registration for EHR incentive programs will be available toward the end of 2010 on our website at http://www.cms.gov/EHRIncentivePrograms . Registration for the Medicare EHR Incentive Program will begin in January 2011 and will be available online. Registration for the Medicaid EHR Incentive Program may also begin in January 2011, but the timing will vary by State.   

Question #9967: Who is responsible for demonstrating meaningful use of certified electronic health record (EHR) technology, the provider or the vendor?

Answer: To receive an EHR incentive payment, the provider (eligible professional (EP), eligible hospital or critical access hospital (CAH)) is responsible for demonstrating meaningful use of certified EHR technology under both the Medicare and Medicaid EHR incentive programs.  

Question #9809: My electronic health record (EHR) system is CCHIT certified, does that mean  it is certified for the Medicare and Medicaid EHR Incentive Programs?

Answer: No. All EHR systems and technology must be certified specifically for this program. Currently, there are no certified EHR products that meet the certification requirements for this program in order to receive an incentive. The Medicare and Medicaid EHR Incentive Programs require the use of certified EHR technology, as established by a new set of standards and certification criteria. Existing EHR technology needs to be certified by an ONC-Authorized Testing and Certification Body (ONC-ATCB) to meet these new criteria in order to qualify for the incentive payments. Through the temporary certification program, new certification bodies will be established to test and certify EHR technology. Upon the “opening” of the certifying bodies, vendors can submit their EHR products to be tested and certified. Hospitals and practices who have developed their own EHR systems or products can also seek to have their existing systems or products tested and certified. Complete EHRs may be certified as well as EHR modules that meet at least one of the certification criteria. Once a product is certified, the name of the product will be published on the ONC web site. It is expected that the first EHRs will be certified and listed on the ONC web site in fall 2010.  

Question #9807: When will CMS begin to pay Medicare and Medicaid EHR incentives to EPs and hospitals (for) the demonstration of meaningful use of certified EHR technology?

Answer: CMS expects that Medicare incentive will begin to be paid in May 2011. Medicaid incentives will be paid by the States and will also begin in 2011 but the timing will vary by State. Under the Medicaid EHR Incentive Program, incentives can also be paid for the adoption, implementation, or upgrade of certified EHR technology.  

Question #9812: What if my electronic health record (EHR) system costs much more than the incentive the government will pay? May I request additional funds?

Answer: The Medicare and Medicaid EHR Incentive Programs provide incentives for the meaningful use of certified EHR technology. Under the Medicaid program, there is also an incentive for the adoption, implementation, or upgrade of certified EHR technology in the first year of participation. The incentives are not a reimbursement of costs, and maximum payments have been set.

Question #9810: What is the maximum incentive an eligible professional (EP) can receive under the Medicaid Electronic Health Record (EHR) Incentive Program?

Answer: EPs who adopt, implement, upgrade, and meaningfully use EHRs can receive a maximum of $63,750 in incentive payments from Medicaid over a six year period (Note: There are special eligibility and payment rules for pediatricians). EPs must begin receiving incentive payments by calendar year 2016.  

Question #9843: Will long term care providers such as nursing homes be eligible for incentive payments under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program?

Answer: Nursing homes, per se, are not eligible. The following types of institutional providers are eligible for EHR incentive payments under Medicare and/or Medicaid, provided they meet the applicable criteria. Under Medicare, institutional providers eligible for the EHR incentive payments include “subsection (d) hospitals,” as defined under section 1886(d) of the Social Security Act, and critical access hospitals (CAHs). Under Medicaid, institutional providers eligible for the EHR incentive payments are acute care hospitals (which include CAHs and cancer hospitals) and children’s hospitals. However, under Medicare, eligible professionals (EPs) may choose to assign their incentive payments to their employer or entity with which the EP has a contractual arrangement. Under Medicaid, EPs also can choose to assign their incentive payments to their employer or to other state-designated entities. 

Question #9846: If an eligible professional (EPs) is currently receiving an incentive payment for e-prescribing under MIPPA, are they also eligible to receive incentive payments under the Medicare and Medicaid EHR Incentive Program?

Answer: The American Recovery and Reinvestment Act of 2009 specifically states that under the Medicare EHR Incentive Program, EPs cannot receive a payment under both the MIPPA E-Prescribing Incentive Program and the Medicare EHR Incentive Program for the same year. However, EPs may receive payments from both the MIPPA E-Prescribing Incentive Program and the Medicaid EHR Incentive Program for the same year.  

Question #9844: Are physicians who practice in hospital-based ambulatory clinics eligible to receive Medicare or Medicaid EHR incentive payments?

Answer: A hospital-based eligible professional (EP) is defined as an EP who furnishes 90% or more of their services in either inpatient or emergency department of a hospital. Hospital-based EPs do not qualify for Medicare or Medicaid EHR incentive payments.  

Question #9808: Can EPs receive EHR incentive payments from both the Medicare and Medicaid programs?

Answer: Not for the same year. If an EP meets the requirements of both programs, they must choose to receive an EHR incentive payment under either the Medicare program or the Medicaid program. After a payment has been made, the EP may only switch programs once before 2015.

Question #9961: What is the reporting period for EPs participating in the EHR incentive programs?

Answer: For demonstrating meaningful use through both the Medicare and Medicaid EHR Incentive Programs, the EHR reporting period for an EP’s first year is any continuous 90-day period within the calendar year. In subsequent years, the EHR reporting period for EPs is the entire calendar year. Under the Medicaid program, there is also an incentive for the adoption, implementation, or upgrade of certified EHR technology, which does not have a reporting period.  

Question #9811: What is the maximum EHR incentive an EP can earn under Medicare?

Answer: EPs who successfully demonstrate meaningful use certified EHR technology as early as 2011 or 2012 may be eligible for up to $44,000 in Medicare incentive payments spread out over five years. EPs who predominantly furnish services in a Health Professional Shortage Area (HPSA) are eligible for a 10 percent increase in the maximum incentive amount.

Question #9845: Will ambulatory surgical centers be eligible for incentive payments under the Medicare and Medicaid EHR Incentive Program?

Answer: Ambulatory surgical centers are not eligible for EHR incentive payments. The following types of institutional providers are eligible for EHR incentive payments under Medicare and/or Medicaid, provided they meet the applicable criteria. Under Medicare, institutional providers eligible for the EHR incentive payments include “subsection (d) hospitals,” as defined under section 1886(d) of the Social Security Act, and critical access hospitals. Under Medicaid, institutional providers eligible for the EHR incentive payments are acute care hospitals (which include critical access hospitals and cancer hospitals) and children’s hospitals.  

Question #9813: What is the earliest date the payment adjustments will start to be imposed on Medicare EPs and eligible hospitals that do not demonstrate meaningful use of certified electronic health record (EHR) technology?

Answer: Medicare payment adjustments will begin in 2015 for EPs and eligible hospitals that do not demonstrate meaningful use of certified EHR technology. There are no payment adjustments associated with the Medicaid provisions under Section 4201 of the American Recovery and Reinvestment Act of 2009.

Question #9815: How will the public know who has received EHR incentive payments?

Answer: As required by the American Recovery and Reinvestment Act of 2009, CMS will post the names, business addresses, and business phone numbers of all Medicare eligible professionals and hospitals who receive EHR incentive payments. There is no such requirement for CMS to publish information on eligible professionals and hospitals receiving Medicaid EHR incentive payments, though individual States may opt to do so.  

Question #9957:  If an EP meets the criteria for both the Medicare and Medicaid EHR incentive programs, can they choose which program to participate in?

Answer: EPs   Yes. EPs who meet the eligibility requirements for both the Medicare and Medicaid incentive programs must elect the program in which they wish to participate when they register. After the initial designation, EPs can only change their program selection once after they have received payment before 2015.   

Question #9959: What safeguards are in place to ensure that Medicaid EHR incentive payments are used for their intended purpose?

Answer: Like the Medicare EHR incentive program, neither the statute nor the CMS final rule dictate how a Medicaid provider must use their EHR incentive payment. The incentives are not a reimbursement and are at the providers’ discretion, similar to a bonus payment.

Question #9958: Are Medicaid EPs and eligible hospitals subject to payment adjustments or penalties if they do not adopt electronic health record (EHR) technology or fail to demonstrate meaningful use?

Answer: There are no payment adjustments or penalties for Medicaid providers who fail to demonstrate meaningful use.

Question #9962: What is the reporting period for eligible hospitals participating in the Medicare and Medicaid EHR Incentive Program?

Answer: For an eligible hospital or critical access hospital’s first payment year, the EHR reporting period is a continuous 90-day period within a Federal fiscal year. In subsequent years, the EHR reporting period for eligible hospitals and critical access hospitals (CAHs) is the entire Federal fiscal year.

Question #10071: Is the physician the only person who can enter information in the EHR in order to qualify for the Medicare and Medicaid EHR Incentive Programs?

Answer: No. The Final Rule for the Medicare and Medicaid EHR incentive programs, specifies that in order to meet the meaningful use objective for computerized provider order entry (CPOE) for medication orders, any licensed healthcare professional can enter orders into the medical record per state, local, and professional guidelines. The remaining meaningful use objectives do not specify any requirement for who must enter information.

Question #9963: Can hospitals in the U.S. Territories qualify for the Medicare and Medicaid EHR Incentive Program?

Answer: Hospitals in the U.S. Territories cannot receive incentive payments under the Medicare EHR Incentive Program. For the purposes of the Medicare EHR Incentive Program, the Social Security Act defines an eligible hospital as a “subsection (d) hospital” that is located in “one of the fifty States or the District of Columbia.” This does not include hospitals located in the U.S. territories. Therefore, hospitals in the U.S. territories do not qualify for the Medicare EHR Incentive Program. However, under the Medicaid EHR Incentive Program, hospitals located in the U.S. Territories are eligible to participate in the Medicaid incentive program as long as they meet all other eligibility requirements.

Question #10095: What do the numerators and denominators mean in measures that are required to demonstrate meaningful use for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program?

Answer: There are 16 measures for EPs and 14 measures for eligible hospitals that require the collection of data to calculate a percentage, which will be the basis for determining if the Meaningful Use objective was met according to a minimum threshold for that objective. Objectives requiring a numerator and denominator to generate this calculation are divided into two groups: one where the denominator is based on patients seen or admitted during the EHR reporting period, regardless of whether their records are maintained using certified EHR technology; and a second group where the objective is not relevant to all patients either due to limitations (e.g., recording tobacco use for all patients 13 and older) or because the action related to the objective is not relevant (e.g., transmitting prescriptions electronically). For these objectives, the denominator is based on actions related to patients whose records are maintained using certified EHR technology. This grouping is designed to reduce the burden on providers. Table 3 in the Medicare and Medicaid EHR Incentive programs final rule (FR 75 44376 – 44380) lists measures sorted by the method of measure calculation. To view the final rule, please visit: http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf .

Question #10084: What is meaningful use, and how does it apply to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs?

Answer: Under the Health Information Technology for Economic and Clinical Health (HITECH Act), which was enacted under the American Recovery and Reinvestment Act of 2009 (Recovery Act), incentive payments are available to eligible professionals (EPs), critical access hospitals, and eligible hospitals that successfully demonstrate are meaningful use of certified EHR technology. The Recovery Act specifies three main components of meaningful use: The use of a certified EHR in a meaningful manner (e.g.: e-Prescribing); The use of certified EHR technology for electronic exchange of health information to improve quality of health care; The use of certified EHR technology to submit clinical quality and other measures. In the final rule Medicare and Medicaid EHR Incentive Program, CMS has defined stage one of meaningful use. To view the final rule, please visit: http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf .   

Question #10081: When can I register and where do I register for the Medicare and Medicaid EHR Incentive Programs?

Answer: Hospitals and eligible professionals (EPs) are expected to be able to register for the program in January 2011. The registration process will be the same for the Medicare and Medicaid programs. You will be able to find registration and other program information at http://www.cms.gov/EHRIncentivePrograms  when it becomes available.    

Question #10094: How do I know if my electronic health record (EHR) system is certified? How can I get my EHR system certified?

Answer: Currently, there are no certified EHR products that meet the certification requirements for the Medicare and Medicaid EHR incentive programs..The Medicare and Medicaid EHR Incentive Programs require the use of certified EHR technology, as established by a new set of standards and certification criteria. Existing EHR technology needs to be certified by an ONC-Authorized Testing and Certification Body (ONC-ATCB) to meet these new criteria in order to qualify for the incentive payments. Through the temporary certification program, new certification bodies will be established to test and certify EHR technology. Upon the “opening” of the certifying bodies, vendors can submit their EHR products to be tested and certified. Hospitals and practices who have developed their own EHR systems or products can also seek to have their existing systems or products tested and certified. Complete EHRs may be certified as well as EHR modules that meet at least one of the certification criteria. Once a product is certified, the name of the product will be published on the ONC web site. It is expected that the first EHRs will be certified and listed on the ONC web site in fall 2010.

Question #10083: Do I need to have an EHR system in order to register for the Medicare and Medicaid EHR Incentive Programs?

Answer: You do not need to have a certified EHR in order to register for the Medicare and Medicaid EHR Incentive Programs. However, to receive an incentive payment under the Medicare program, you must attest that you have demonstrated meaningful use of certified EHR technology during the EHR reporting period. For the first year of payment, the EHR reporting period is 90 consecutive days within the calendar year for eligible professionals (EPs) or within the Federal fiscal year for eligible hospitals and critical access hospitals (CAHs). With regard to the Medicaid EHR Incentive program, for the first year of payment, EPs and hospitals must have adopted, implemented, upgraded certified EHR technology before they can receive an EHR incentive payment from the State. As an alternative to demonstrating that they have adopted, implemented or upgraded certified EHR technology, for the first year of payment, the EP or hospital may demonstrate that they are meaningful users of certified EHR technology for the 90-day EHR reporting period.

Question #10076:  In a group practice, will each provider need to demonstrate meaningful use  in order to get Medicare and Medicaid electronic health record (EHR) incentive payments or can meaningful use be calculated or averaged at the group level?

Answer: Yes. Medicare and Medicaid incentive payments are made on a per EP basis, not by practice. Each EP will need to demonstrate the full requirements of meaningful use in order to qualify for the EHR incentive payments. We made this clear in the preamble to the final rule when we declined to adopt alternative means for demonstrating meaningful use on a group-practice level (75 FR 44437). To view the final rule for the Medicare and Medicaid EHR incentive programs, please visit: http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf .

Question #10068: For EPs who practice in multiple settings, where should EPs base their denominators for meaningful use objectives on the number of unique patients?

Answer: In this case, EPs should base both the numerators and denominators for meaningful use objectives on the number of unique patients in the clinic setting, since this setting is where they are eligible to receive payments from the Medicare and Medicaid EHR Incentive Programs.

Question #10069: Are eligible professionals (EPs) who practice in State Mental Health and Long Term Care Facilities eligible for Medicaid EHR incentive payments  if they meet the eligibility criteria (e.g., patient volume, non-hospital based, certified EHR)?

Answer: The setting in which a physician, nurse practitioner, certified nurse-midwife, or dentist practices is generally irrelevant to determining eligibility for the Medicaid EHR Incentive Program (except for purposes of determining whether an EP can qualify through “needy individual” patient volume). Setting is relevant for physician assistants (PA), as they are eligible only when they are practicing at a Federally Qualified Health Center (FQHC) that is led by a PA or a Rural Health Center (RHC) that is so led. All providers must meet all program requirements prior to receiving an incentive payment (e.g. adopt, implement or meaningfully use certified EHR technology, patient volume, etc.).

Question #10086: Can an EP implement an EHR system and satisfy meaningful use requirements at any time within the calendar year  for the Medicare and Medicaid EHR Incentive Program?

Answer: For a Medicare EP’s first payment year, the EHR reporting period is a continuous 90-day period within a calendar year, so an EP must satisfy the meaningful use requirements for 90 consecutive days within their first year of participating in the program to qualify for an EHR incentive payment. In subsequent years, the EHR reporting period for EPs will be the entire calendar year. With regard to the Medicaid EHR Incentive program, EPs must have adopted, implemented, upgraded, or meaningfully used certified EHR technology during the first calendar year. If the Medicaid EP adopts, implements or upgrades in the first year of payment, and demonstrates meaningful use in the second year of payment, then the EHR reporting period in the second year is a continuous 90-day period within the calendar year; subsequent to that, the EHR reporting period is then the entire calendar year.

Question #10067: Do controlled substances qualify as “permissible prescriptions” for meeting the eRx meaningful use objective under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs?

Answer: The term “permissible prescriptions” refers to the restrictions that were established by the Department of Justice (DOJ) on electronic prescribing (eRx) for controlled substances in Schedule II. (The substances in Schedule II can be found at http://www.deadiversion.usdoj.gov/schedules/orangebook/e_cs_sched.pdf ). Any prescription not subject to these restrictions would be a permissible prescription. Although DOJ recently published an Interim Final Rule that allows the electronic prescribing of these substances, we were unable to incorporate these recent guidelines into the Final Rule for the Medicare and Medicaid EHR Incentive Programs. Therefore, the determination of whether a prescription is a ”permissible prescription” for purposes of the eRx meaningful use objective should be made based on the guidelines for prescribing Schedule II controlled substances in effect on or before January 13, 2010, when the notice of proposed rulemaking for the Medicare and Medicaid EHR Incentive Program was published in the Federal Register.   

Question #10072:  Do I need to report on the CQMs for the Medicare and Medicaid EHR Incentive Program for which I do not have any data?

Answer: EPs are not excluded from reporting clinical quality measures, but zero is an acceptable value for the CQM denominator. If there were no patients who met the denominator population for a CQM, then the EP would report a zero for the denominator and a zero for the numerator. For the core measures, if the EP reports a zero for the core measure denominator, then the EP must report results for up to three alternate core measures (potentially reporting on all 6 core/alternate core measures). For the menu-set measures, we expect the EP to report on measures which do not have a denominator of zero. If none of the measures in the menu set applies to the EP, then the EP must report on three of such measures, reporting a denominator of zero, and then attest that the remainder of the menu-set measures have a value of zero in the denominator. As we stated in the final rule (75 FR 44409-10): “The expectation is that the EHR will automatically report on each core clinical quality measure, and when one or more of the core measures has a denominator of zero then the alternate core measure(s) will be reported. If all six of the clinical quality measures in Table 7 have zeros for the denominators (this would imply that the EPs patient population is not addressed by these measures), then the EP is still required to report on three additional clinical measures of their choosing from Table 6 in this final rule. In regard to the three additional clinical quality measures, if the EP reports zero values, then for the remaining clinical quality measures in Table 6 (other than the core and alternate core measures) the EP will have to attest that all of the other clinical quality measures calculated by the certified EHR technology have a value of zero in the denominator, if the EP is to be exempt from reporting any of the additional clinical quality measures (other than the core and alternate core measures) in Table 6.”  To view the final rule, please visit:  http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf . 

Question #10077: Can the drug-drug and drug-allergy interaction alerts of my EHR also be used to meet the meaningful use objective for implementing one clinical decision support rule for the Medicare and Medicaid EHR Incentive Programs?

Answer: No. The drug-drug and drug-allergy checks and the implementation of one clinical decision support rule are separate core meaningful use objectives. EPs and eligible hospitals must implement one clinical decision support rule in addition to drug-drug and drug-allergy interaction checks. We would not have listed these core requirements as separate measures, nor required that EPs and hospitals meet all core objectives and measures listed in the regulation, had we intended for them to be met simultaneously.   

Question #10088: If I am receiving payments under the CMS Electronic Prescribing (eRx) Incentive Program, can I also receive Medicare and Medicaid Electronic Health Record (EHR) incentive payments?

Answer: If the eligible professional (EP) chooses to participate in the Medicare EHR Incentive Program, they cannot participate in the eRx Incentive Program in the same program year. If the EP chooses to participate in the Medicaid EHR Incentive Program, they can participate in the Medicare eRx Incentive Program simultaneously.   

Question #10075: Can EPs use clinical quality measures from the alternate core set to meet the requirement of reporting three additional measures for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs?

Answer: No, if EPs report data on all three clinical quality measures from the core set, they would not report on any from the alternate core set. The three additional clinical quality measures must come from Table 6 of the final rule (75 FR 44398-44408), excluding those clinical quality measures included in either the core set or the alternate core set. To view the final rule for the Medicare and Medicaid EHR incentive programs, please visit: http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf .

Question #10078: What is the difference between the Electronic Health Records (EHR) Demonstration and the Medicare and Medicaid EHR Incentive Programs?

Answer: The EHR Demonstration is a five-year demonstration project designed to encourage small to medium-sized primary care physician practices to adopt and use EHRs to improve the quality of patient care. Practices participating in the EHR Demonstration that meet specified requirements are eligible to receive two types of incentive payments: one for the adoption and use of an EHR and one for the reporting of and performance on 26 clinical quality measures related to the care of diabetes mellitus (DM), congestive heart failure (CHF), coronary artery disease (CAD) and preventive care services. The demonstration was implemented on June 1, 2009 in the following 4 sites: Louisiana, Southwest Pennsylvania, South Dakota (and some counties in bordering states), and Maryland and the District of Columbia. After careful consideration, plans to add 8 additional sites to the demonstration one year later were discontinued due to the creation of the Medicare and Medicaid EHR incentive programs. The EHR Demonstration will continue through May 31, 2014. CMS has no plans to add sites or additional primary care physician practices to the EHR Demonstration. The Medicare and Medicaid EHR Incentive Programs was established under the Health Information Technology for Economic and Clinical Health Act, or the “HITECH Act,” which is part of the Recovery Act. The EHR Incentive Programs under Medicare and Medicaid will provide incentive payments for the “meaningful use” of certified EHR technology. The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals (EPs), critical access hospitals, and eligible hospitals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. The programs will begin in 2011. For more information about the EHR Demonstration, please visit: http://www.cms.gov/demoprojectsevalrpts/md/itemdetail.asp?itemid=cms1204776 .

Question #10074: Are physicians who work in hospitals eligible to receive Medicare or Medicaid EHR incentive payments?

Answer: Physicians who furnish substantially all, defined as 90% or more, of their covered professional services in either an inpatient (POS 21) or emergency department (POS 23) of a hospital are not eligible for incentive payments under the Medicare and Medicaid EHR Incentive Programs.  

Question #10091: Can I receive the maximum allowable electronic health record (EHR) incentive payments if they total more than the purchase cost of my EHR system?

Answer: Yes. As long as an eligible professional (EP) or eligible hospital meets all necessary requirements for qualifying for incentive payments, they will receive the maximum incentive payment amount, regardless of the purchase or implementation costs of their EHR system. For Medicaid, there is a requirement that an EP is responsible for at least 15% of net average allowable costs in each year. In the first year, this means the EP is responsible for expenditures of at least $3,750. The final rule for the Medicare and Medicaid EHR incentive programs provides additional explanation of what it means for the EP to be “responsible” for such amount, including allowing an employer of the EP to incur the $3,750 on the EP employee’s behalf. However, theoretically, there could be a situation where neither the EP, nor his or her employer expends more than $3,750 in total costs on the certified EHR technology. To view the final rule, please visit: http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf .

Question #10093: What is the purpose of certified electronic health record (EHR) technology?

Answer: Certification of EHR technology will provide assurance to purchasers and other users that an EHR system or product offers the necessary technological capability, functionality, and security to help them satisfy the meaningful use objectives for the Medicare and Medicaid EHR Incentive Programs. Providers and patients must also be confident that the electronic health information technology (IT) products and systems they use are secure, can maintain data confidentially, and can work with other systems to share information. Confidence in health IT systems is an important part of advancing health IT system adoption and realizing the benefits of improved patient care.

Question #10070: If a patient is dually eligible for both Medicare and Medicaid, can they be counted twice by hospitals in their calculations

Answer: For purposes of calculating the Medicaid share, a patient cannot be counted in the numerator if they would count for purposes of calculating the Medicare share. Thus, in this respect the inpatient bed day of a dually eligible patient could not be counted in the Medicaid share numerator. (See 1903(t)(5)(C), stating that the numerator of the Medicaid share does not include individuals “described in section 1886(n)(2)(D)(i).”) In other respects; however, the patient would count twice. For example, in both cases, the individual would count in the total discharges of the hospital. To view the final rule for the Medicare and Medicaid EHR incentive programs, please visit: http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf .

Question #10090: Are there any special incentives for rural providers in the EHR Incentive Programs?

Answer: Under the Medicare EHR Incentive Program, the annual incentive payment limit for each payment year will be increased by 10 percent for eligible professionals (EPs) who predominantly furnish services in a Health Professional Shortage Area (HPSA). Critical access hospitals (CAHs) can receive an incentive payment amount equal to the product of its reasonable costs incurred for the purchase of certified EHR technology and the Medicare share percentage. Under Medicaid, there are no additional incentives for rural providers, beyond the incentives already available.

Question #10087: Can an eligible hospital implement an EHR system and satisfy meaningful use requirements at any time

Answer: For an eligible hospital’s first payment year, the EHR reporting period is a continuous 90-day period within a Federal Fiscal Year, so an eligible hospital must satisfy the meaningful use requirements for 90 consecutive days within their first Federal Fiscal Year of participating in the program to qualify for an EHR incentive payment. In subsequent years, the EHR reporting period for eligible hospitals will be the entire Federal Fiscal Year. With regard to the Medicaid EHR Incentive program, eligible hospitals must have adopted, implemented, upgraded, or meaningfully used certified EHR technology during the first Federal Fiscal Year. If the Medicaid eligible hospital adopts, implements or upgrades in the first year of payment, and demonstrates meaningful use in the second year of payment, then the EHR reporting period in the second year is a continuous 90-day period within the Federal fiscal year; subsequent to that, the EHR reporting period is then the entire Federal fiscal year. 

Question #10080: When do the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs start?

Answer: Participation in the Medicare EHR Incentive Program can begin as early as 2011; The incentive program ends in 2016. Registration for the Medicare EHR Incentive Program is expected to begin in January 2011, with attestation beginning in April 2011.The earliest incentive payments to eligible professionals (EPs) and eligible hospitals are expected to be made in May 2011. Medicaid EHR Incentive Program is voluntarily offered by individual states and may begin as early as 2011 and will end in 2021. Registration for the Medicaid incentive program is expected to begin in January 2011. Participants in the Medicaid EHR Incentive Program should consult their State for specific information regarding attestation and payment.

Question #10085:  The meaningful use standards for the EHR Incentive Program require interoperability. Who will pay for ensuring connectivity between physician practices and hospitals? Will there be federal guidance, or will this be hashed out at a local/community level?

Answer: The Office of the National Coordinator for Health Information Technology (ONC) has awarded funds to 56 states, eligible territories, and qualified State Designated Entities (SDEs) under the Health Information Exchange Cooperative Agreement Program to help fund efforts to rapidly build capacity for exchanging health information across the health care system both within and between states. These exchanges will play a critical role in facilitating the exchange capacity of doctors and hospitals to help them meet interoperability requirements which will be part of meaningful use. More information on ONC’s Health Information Exchange grantees is available at: http://healthit.hhs.gov/ .

Question #10073: Do recipients of Medicare or Medicaid EHR incentive payments need to file reports under Section 1512

Answer: No. The Medicare and Medicaid EHR incentive payments made to providers are not subject to Recovery Act 1512 reporting because they are not made available from appropriations made under the Act; however, the Health Information Technology for Clinical and Economic Health (HITECH) Act does require that information about eligible professionals (EPs), eligible hospitals and CAHs participating in the Medicare fee-for-service (FFS) or Medicare Advantage (MA) EHR incentive programs be posted on our website.

Question #10079: If I am participating in the Medicare EHR Demonstration Program, can I also participate in the Medicare and Medicaid EHR Incentive Programs?

Answer: Yes, if the eligible professional (EP) is eligible they may simultaneously participate in the Medicare EHR Demonstration and the Medicare or Medicaid EHR Incentive Program. For more information about the EHR Demonstration, please visit: http://www.cms.gov/demoprojectsevalrpts/md/
itemdetail.asp?itemid=cms1204776 .

Question #10082: Are mental health practitioners eligible to participate in the Medicare and Medicaid EHR Incentive Programs?

Answer: Mental health providers would only be eligible for incentive payments if they meet the criteria of a Medicare or Medicaid eligible professionals (EPs).  For more complete information about eligibility requirements, please refer to the Eligibility section of the CMS website at http://www.cms.gov/EHRIncentivePrograms/20_Eligibility.asp#TopOfPage .

Question #9965: Can EPs in the U.S. Territories qualify for EHR incentive payments?

Answer: Yes, EPs in the U.S. Territories can receive EHR incentive payments under both the Medicare and Medicaid EHR Incentive Programs as long as they meet the applicable requirements. EPs must choose whether to participate in the Medicare or Medicaid EHR Incentive Program.  

Question #10089: How much are the Medicare and Medicaid Electronic Health Record (EHR) incentive payments to EPs?

Answer: Under the Medicare EHR Incentive Program, EPs who demonstrate meaningful use of certified EHR technology can receive up to a total of $44,000 over 5 consecutive years. Additional incentives are available for Medicare EPs who practice in a Health Provider Shortage Area (HPSA). Under the Medicaid EHR Incentive Program, EPs can receive up to a total $63,750 over the 6 years that they choose to participate in program. EPs may switch once between programs after a payment has been made and only before 2015.

Question #10092: Where can I get answers to my privacy and security questions about electronic health records (EHRs)?

Answer: The Office for Civil Rights (OCR) is responsible for enforcing the Privacy and Security rules related to the HITECH program. More information is available at OCR’s website at http://www.hhs.gov/ocr/ .

Question #9966: Can EPs in Washington, D.C., receive electronic EHR incentive payments?

Answer: Yes, EPs in the District of Columbia can receive EHR incentive payments under the Medicare or Medicaid program as long as they meet the program’s requirements. EPs in D.C. are subject to the same requirements as EPs in the 50 States and thus may not concurrently receive payments from both the Medicare and Medicaid EHR Incentive Programs.  

Question #9964: Can hospitals in Washington, D.C. receive the EHR incentive payments?

Answer: Yes, hospitals in the District of Columbia can receive the Medicare and/or Medicaid EHR incentive payments as long as the hospitals meet the requirements for each program.
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Please be advised that the above FAQs were generated and excerpted from a database that is updated frequently by the Centers for Medicare and Medicaid Services (CMS).

For the most up-to-date official CMS information, please visit http://questions.cms.hhs.gov or click here to get the latest CMS FAQs on the Electronic Health Records Incentive Program. To get the latest answer on a specific question above, go to either of the links in the previous sentence, use the search box labelled “Find the answer to  your question” located just above the FAQs, type in the four digits only of the “Answer #”, and click “Search”. The general CMS search box does not work the same way.

The url to get the complete list of CMS FAQs on EHR Incentive Program:
http://questions.cms.hhs.gov/app/answers/list/p/21,26,1058