Medicaid Meaningful Use

You could qualify for $21,250 per provider by the end of 2016.

It's possible, and you might want to look into it because you're going to be doing most of this stuff anyway in 2017.

The last year to start participating in the Medicaid Meaningful Use program is 2016, which is wrapping up quickly! Under this program, Eligible Professionals (EPs) can qualify for $63,750 in payments over 6 years, with a first year payment of $21,250 per provider (not group, PROVIDER). The purpose of this program is to incentivize EPs to adopt certified EHR technologies (CEHRT).

The requirements:

  • Eligible Providers must have a payor mix of 30% Medicaid patients over a 90-day period at some point in 2016
  • Eligible Providers must adopt a CEHRT certified EHR (this is where we can help!)

Our users primarily see patients in post-acute facilities, which is predominantly paid for by Medicare. However, many of these patients are dual eligibles where Medicare is the primary coverage for a patient, and Medicaid is a secondary payor. These patients count when calculating the payor mix, even if Medicare is the payor for the encounters.

If you enter the Medicaid MU Program, you must do so in 2016. You don't have to demonstrate Meaningful Use to receive the initial payment of $21,250 in 2016 and you don't have to continue to demonstrate Meaningful Use in following years. However, if you do, you will receive $8,500 per year per EP in your practice for the next five years.

THIS IS ICING ON THE CAKE!! With Medicare's new MACRA legislation (Medicare Access and CHIP Reauthorization Act) comes new payment structures, specifically MIPS (the Merit-based Incentive Payment System). MIPS is essentially a combination of PQRS (Physician Quality Reporting System), VPM (Value-based Payment Modifier) and Meaningful Use Stage 3. The big kicker here? Providers will be required to use Certified EHR Technology (the MU 3 part) and report on clinical data for patients (the PQRS part). Based on the data reported and the technology used, providers will have Medicare reimbursements adjusted with either a bonus or a reduction starting in 2019.

We'll dive into MIPS and what that means for your Post-Acute practice of medicine in another post. The point here is YOU'RE GOING TO HAVE TO BASICALLY MEET MEANINGFUL USE ANYWAY, so why not get paid for it?!

$8,500 over the next few years can do quite a bit. Not even half of that amount will pay for a full year of ChartPath ($250 per provider per month). You can use the other $5,500 and buy an old MG B, like Buzz did, or pay for professional ping pong skills and try to beat our in-house champion, Donovan, or use it to buy a Smart Car and start a home health business (we can help there too!). $8,500 won't even pay for licensing fees of most of our competitors.

We're always here to help our users. If you have any questions about this program or would like some help getting started, don't hesitate to reach out to us! Our team of experts, led by our CMIO, Dr. Charles Owen, are always on call for you. We believe in partnering with our users, not just providing technology. Our goal is to help you run a Perfect Practice!

And because Afoundria is currently undergoing the CEHRT certification process for ChartPath, our technologies will meet all your requirements to run a perfect practice (including those requirements set forth in the MU programs and future payment models).

You can call us directly at (888) 632-4659 or email Buzz, our Chief Product Officer, at buzz@afoundria.com or Jon, our CEO, at jon@afoundria.com.

Some funny bits about Medicaid MU:

  • Your entire group can qualify even if some of the providers only see 1 Medicaid patient in the 90 days. The group average must be 30% of patients on Medicaid, anyone in the group under 30% can be carried along with the other providers. So if you have 5 providers, and one only sees 5% Medicaid, but the rest see 40% Medicaid, and the overall group average is 30% or higher, then that is 5 checks for $21,500.
  • Nurse Practitioners ARE eligible under the Medicaid MU program (they were not under Medicare's MU program). Physician Assistants and non mid-level providers won't qualify, but they can be used to help an EP qualify.
  • Unlike Medicare's MU program, you don't have to continuously show Meaningful Use for years and years, you just have to report on the percentage of Medicaid covered patients over a 90 day period in 2016. The program was truly designed to simply incentivize the implementation of CEHRT (Certified EHR Technology) EHR systems in provider practices. The Medicare MU program was designed to incentivize achieving Meaningful Use (which means "Using" the CEHRT technology in a Meaningful manner).
  • There are no penalties for not meeting Meaningful Use (at least from this program... there are other penalties, lots of them, and we'll cover those in another post).
  • Medicare MU required providers to show Meaningful Use before receiving payment, Medicaid's MU program does not!