Healthcare industry emphasizes on value-based medical services to patients with the correct use of technology and innovation. The purpose is to empower physicians’ RCM and patients with the right to choose quality care services. MIPS is a great addition in this context. It allows physicians taking small steps towards a better healthcare system. However, along with MIPS, the Medicare EHR incentive program also shares the responsibility with the same approach.
Since many hospitals don’t use EHR technology until now. However, the healthcare industry will only progress forward in a secure environment when using the latest technologies. For encouraging physicians and boosting their RCM, The American Recovery and Reinvestment Act of 2009 (ARRA) initiated a program under Medicare. It was to facilitate eligible physicians to use the Certified Electronic Health Record (CEHR) technology meaningfully.
CMS named this program as Medicare Promoting Interoperability (PI) since last year. MIPS also contains this category featuring the benefits of this program, ensuring advancement in healthcare services with the appropriate use of EHRs. This measure appreciates interoperability efforts and applauses for allowing reasonable access of patients to information.
What if Clinicians don’t meet the Promoting Interoperability (PI) criteria!
Healthcare organizations that don’t illustrate correct depiction of PI will not get payment adjustment for the respective year.
Healthcare, which participates in both incentive programs i.e; Medicare and Medicaid EHR programs can subject to payment adjustments only when it demonstrates the true value in its reporting.
Reporting Criteria for EHR Incentive Program
Prior to 2018, physicians demonstrated EHR use via either CMS Medicare EHR Incentive Programs Attestation System or the state’s attestation system. Now, QNet System confirms the EHR meaningful use and payment adjustments are calculated via a formula specified by the CMS.
What Expectations should clinicians have for payment adjustments for 2019?
Eligible healthcare organizations, which are not meaningful EHR users, get payment adjustment as a reduction to the applicable percentage proportional to the Inpatient Prospective Program System (IPPS). Thus, it reduces the IPPS standardized amount of healthcare centers.
What are the hardship exceptions?
Eligible hospitals can avoid negative payment adjustments through hardship exceptions on day-to-day scenarios. Sometimes, CMS itself determines that eligible healthcare falls in an exceptional case.
To apply as an exception, clinicians or hospitals can get information on the official CMS website.
Given below are the categories for hardship exception cases.
1. New Eligible Healthcare Organizations
Healthcare organizations having new CMS Certification Numbers (CCNs) and insufficient time to submit data can get relaxation for 1 year.
2. Infrastructure Liabilities
Eligible hospitals having no Internet access in their operating area or with insufficient resources to meet the threshold of EHR meaningful use.
3. Unexpected Circumstances
In the case of natural disasters or unforeseen conditions.
4. Vendor Related Issues
Hospitals can apply for this category when they encounter EHR vendor issues to obtain a certification or due to related delays.
What will physicians get in return for their efforts?
- The foremost purpose is to avoid negative Medicare payment adjustment, and thus revenue cycle management becomes efficient, supporting all the financial matters.
- The healthcare system improves, and the transparency travels across the board from a higher level to a lower level.
Thus, EHR technology is not just about technology incorporation but a way to fill gaps between patient and physician. Moreover, the advancement in its context helps in successfully submitting clinical data for MIPS as well. Consequently, the healthcare industry flourishes.
Consult the official CMS website for further information https://www.cms.gov EHRIncentivePrograms
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- EHR incentive program
- The result when not submit data for this program
- Payment adjustment criteria
- Hardship exceptional cases