What are the details on receiving payment for Stage 1?

  • Details vary between Medicare and Medicaid, please see the CMS website for full detailed information
  • One lump sum check each year
  • Medicare Incentive Payment Calculation: 75% of allowable Medicare charges with a yearly maximum (see table below)
  • Medicare Payment Timeline: After meaningful use requirements have been met and reported, payments are sent four to six weeks after the maximum incentive is reached (exception for Medicaid Program year one of adption and implementation)
  • Medicaid Incentive Payments: Flat yearly payment maximum (not claims based) (see table below)
  • Medicaid Payment Timeline: States will pay no later than 5 months after you register; most sooner.
 
 

Meaningful Use Requirement Timelines and Medicare Maximum Payments/Adjustments

First Payment Year Stage of Meaningful Use
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
2011 1 1 1 2* 2 3 3 TBD TBD TBD TBD
$44,000 overall $18,000 $12,000 $8,000 $4,000 $2,000            
2012   1 1 2* 2 3 3 TBD TBD TBD TBD
$44,000  overall   $18,000 $12,000 $8,000 $4,000 $2,000          
2013     1 1* 2 2 3 3 TBD TBD TBD
$39,000  overall     $15,000 $12,000 $8,000 $4,000          
2014       1* 1 2 2 3 3 TBD TBD
$24,000  overall       $12,000** $8,000 $4,000          
2015         1 1 2 2 3 3 TBD
penalties         -1%            
2016           1 1 2 2 3 3

penalties

        -1% -2%          
2017             1 1 2 2 3
penalties         -1% -2% -3%        

 *3-month quarter EHR reporting period for Medicare and continuous 90-day EHR reporting period (or 3 months at state option) for Medicaid EPs. All providers in their first year in 2014 use any continuous 90-day EHR reporting period.

Note: Medicare EHR incentive payments made are subject to the mandatory reductions in federal spending known as sequestration. This 2% reduction will be applied to any Medicare EHR incentive payment for a reporting period that ends on or after April 1, 2013. If the final day of the reporting period occurs before April 1, 2013, those incentive payments will not be subject to the reduction

**First year Medicare and Medicaid providers must complete 90 days of Meaningful Use before Oct. 1, 2014 to avoid the 2015 Medicare payment adjustment of 1%. Providers in year two or three of MU must meet MU for a full year in 2013 to avoid the payment adjustment in 2015.

Note: In 2015, Medicare EP's not demonstrating meaningful use will have payment adjustments starting at 1% the first year and increasing each year to a maximum of 5%.

 

Medicaid Incentive Payments

First Payment Year Stage of Participation/Meaningful Use
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
2011 A,I,U 1 1 2 2 3 3 TBD TBD TBD TBD
$63,750 $21,250 $8,500 $8,500 $8,500 $8,500            
2012   A,I,U 1 1 2 2 3 3 TBD TBD TBD
$63,750    $21,250 $8,500 $8,500 $8,500 $8,500 $8,500        
2013     A,I,U 1 2 2 3 3 TBD TBD
$63,750      $21,250 $8,500 $8,500 $8,500 $8,500        
2014       A,I,U 1 1 2 2 3 3 TBD
$63,750        $21,250  $8,500* $8,500 $8,500  $8,500       
2015         A,I,U 1 1 2 2 3 3
$63,750          $21,250* $8,500* $8,500  $8,500  $8,500     
2016         * A,I,U 1 1 2 2 3
$63,750          $21,250* $8,500* $8,500  $8,500  $8,500   

 *Medicaid EPs are subject to a Medicare payment adjustment if they have not met and demonstrated MU. One percent Medicare payment adjustments begin in 2015 and increase each year.

Notes:

  • Pediatricians with a Medicaid patient volume of 20%-30% have lower annual maximums.
  • Eligible Professionals have already received payment under the Medicaid program simply by adopting and implementing a certified EHR/EMR in 2011.
  • Starting in 2013, Medicaid patient encounter volumes include any encounters with Medicaid eligible patients.

 

 


 

Note: All information provided is intended to be a helpful overview.  Please visit the CMS website for the written law and regulations.

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