Meaningful Use and EHR Medicare/Medicaid Incentive Payment The American Recovery and Reinvestment Act of 2009 (ARRA) authorizes the Centers for Medicare & Medicaid Services (CMS) to provide reimbursement incentives for eligible professionals who are successful in becoming “meaningful users” of certified electronic health record (EHR) technology. The law includes the Health Information Technology for Economic and Clinical Health Act, or the "HITECH Act," which established incentive programs under CMS. On July 13, 2010, CMS issued its final rule on the Electronic Health Record (EHR) Incentive Programs under Medicare and Medicaid. The Final Rule established the criteria and reporting requirements, which eligible professionals follow to prove meaningful use of their adopted Electronic Health Record technology.

CMS Final Rule: released on July 13, 2010. Brief Outline: Eligible providers (EP) must be able to demonstrate and report “Meaningful Use” by adopting a certified EHR (electronic health record) technology.

The software system adopted must meet a set of specific requirements to be considered “certified” electronic health record (EHR) technology.

The eligible provider (EP) must adhere to and complete a series of criteria in order to qualify as a meaningful user of health information technology (HIT) to receive incentive payments.

The EP must properly report the established series of clinical quality measures (CQM) in order to receive the incentive payments.

The ONC (Office of the National Coordinator) The Office of the National Coordinator for Health Information Technology was created in 2004, through an Executive Order, and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009.

The HITECH legislation directs the ONC to support and promote meaningful use of certified electronic health record (EHR) technology nationwide through the adoption of standards, implementation specifications, and certification criteria as well as the establishment of certification programs for HIT, such as EHR technology.

Authorized Testing Certification Bodies(ATCB) have been identified by the ONC, to test and certify that certain types of EHR technology (complete EHRs and EHR modules) are compliant with the standards, implementation specifications, and certification criteria adopted by the Health and Human Services (HHS) Secretary and meet the definition of “certified EHR technology.”

Any adopted EHR must be certified by the ONC-ATCBs in order to qualify for the Medicare/Medicaid incentive payments.

Stage of Meaningful Use Criteria by Payment Year The following table outlines the CMS proposal to apply the respective criteria of meaningful use, in stages, for each payment year (first, second, third, etc.) for eligible providers and eligible hospitals that become meaningful EHR users before 2015. Nothing in the proposed rule limits CMS from making proposed changes to meaningful use beyond Stage 3.



Meaningful use will happen in three stages. Stage 1 will begin in 2011. In 2013, stage 2 will begin. Stage 2 will add more requirements and new reports. Stage 3 will begin in 2015 and is expected to add more requirements.

Meaningful use Stage 1:Have a certified electronic health record(EHR) and to be able to demonstrate that it is being used to meet the requirements of : 1. Health IT Functionality measures and 2. Clinical Quality measures.

Meaningful use Stage 2:Stage 2 would expand upon the Stage 1 criteria in the areas of disease management, clinical decision support, medication management support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies.

Meaningful use Stage 3: Outcome based measures would focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes.


CMS Medicare and Medicaid Milestone Timeline



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Medicare and Medicaid Incentive Payouts At-A-Glance:

Year of adoption  HITECH incentive Program payout over time 2011 $18,000       2012 $12,000 $18,000     2013 $8,000 $12,000 $15,000   2014 $4,000 $8,000 $12,000 $15,000 2015 $2,000 $4,000 $8,000 $8,000 2016   $2,000 $4,000 $8,000 Total $44,000 $44,000 $39,000 %35,000

Medicaid HITECH Incentive Timeline

Year of adoption  HITECH incentive Program payout over time 2011 $25,000             2012 $10,000 $25,000           2013 $10,000 $10,000 $25,000         2014 $10,000 $10,000 $10,000 $25,000       2015 $10,000 $10,000 $10,000 $10,000 $25,000   1% penalty 2016   $10,000 $10,000 $10,000 $10,000 $25,000 2% penalty 2017     $10,000 $10,000 $10,000 $10,000 3% penalty 2018       $10,000 $10,000 $10,000   2019         $10,000 $10,000   2020           $10,000   Total $65,000 $65,000 $65,000 $65,000 $65,000 $65,000

e-Prescribe Incentive

Year of adoption  Incentive  Penalty 2009 2.0% - 2010 2.0% - 2011 1.0% -0.5% 2012 0.5% -1.0% 2013   -2.0%