The Centers for Medicare and Medicaid Services has issued one new and two updated Frequently Asked Questions about the electronic health records meaningful use program:

 

What funding sources may States use to fund the 10% non-federal share of HITECH administrative expenditures?

States must fund the 10 percent non-federal share of the Health Information Technology (HITECH) Act administrative expenditures consistent with the law and regulations applicable to the non-federal share for all Medicaid expenditures.   Consistent with that authority, which includes Social Security Act sections 1902(a)(2), 1903(a), 1903(w), and 42 CFR Part 433, subpart B, states may fund the non-federal share of Medicaid expenditures through legislative appropriations to the Medicaid agency, intergovernmental transfers (IGTs), certified public expenditures (CPEs), permissible health-care related taxes, and bona-fide donations. 

States must submit their proposed strategies for funding the non-federal share of HITECH administrative payments to CMS for review as part of the HIT plan approval process.  CMS will review each individual State’s proposal to ensure that each proposed non-federal share funding source meets federal requirements.  During this process, CMS can address specific questions about funding the non-federal share of Medicaid expenditures.

CMS strongly urges States to work on their funding proposals with their CMS HIT Coordinators as early as possible before claiming for HITECH administrative expenditures, to ensure funding structures are appropriate.  HITECH administrative expenditures, like other title XIX expenditures, are subject to audit, and federal funds may be at risk if funding sources are found not to be in compliance with federal requirements. 

Below are some statutory and regulatory citations pertaining to non-federal share financing requirements.  Please note this is not an all-inclusive list of funding requirements. 

• Use of Federal Funds
o Social Security Act §1903
o 42 CFR 433.51(c)

• State Appropriations
o Social Security Act §1902(a)(2)
o 42 CFR 433.51

• Intergovernmental Transfers
o Social Security Act §1903(w)(6)(A)
o 42 CFR 433.51

• Certified Public Expenditures
o Social Security Act §1903(w)(6)(A)
o 42 CFR 433.51

• Healthcare-Related Taxes and Provider-Related Donations
o 42 CFR part 433, subpart B

 

What are the specific medical specialty codes associated with anesthesiology, radiology and pathology for the specialty-based determination for the granting of a hardship exception from the payment adjustments in the Medicare Electronic Health Record (EHR) Incentive Program?

The included Medicare Specialty Codes are diagnostic radiology (30), nuclear medicine (36), interventional radiology (94), anesthesiology (05), and pathology (22).

We note that current practice guidelines issued by the American College of Radiology for interventional radiology (94) indicate that both face-to-face patient contact (pre and post procedure) and follow-up care (longitudinal care) are expected as part of the scope of practice, and we may need to revisit this issue in future rulemaking.

Radiation oncology, together with surgical and medical oncology, is one of the 3 primary disciplines involved in cancer treatment according to the American College of Radiology practice guidelines. Radiation oncologists are therefore specialized oncologists as opposed to specialized radiologists and are not eligible for the specialty-based exception. If a radiation oncologist believes they meet the hardship exception criteria for lack of face-to-face patient interaction and lack of need for follow-up care they may apply for that exception, as can any eligible professional regardless of specialty.

 

For the Medicare Electronic Health Record (EHR) Incentive Program, how are incentive payments determined for eligible professionals practicing in a Health Professional Shortage Area (HPSA)?

Health Professional Shortage Area (HPSA) refers to an area determined to have a shortage of health professional(s).  Medicare eligible professionals (EPs) participating in the EHR Incentive Program who predominantly furnish services in a geographic HPSA are entitled to an incentive payment limit increase for each payment year.  In the Medicare EHR Incentive Program, an EP is considered eligible for the HPSA incentive if more than 50% of his or her covered professional services (e.g., Medicare Part B payments) are furnished in an area that is determined to be a geographic HPSA as of December 31st of the prior year. 

Per the statute and the final rule, EPs who predominately furnish their services in a geographic HPSA and who have received the maximum non-HPSA incentive payment have their annual EHR incentive payment limit increased by 10%.   The calculated allowed charge amount of the incentive payment for an EP who has predominantly furnished services in a geographic HPSA is 75% of the total allowed charges minus the non-HPSA incentive payment amount. 

The EP who has predominantly furnished services in a geographic HPSA will earn a HPSA payment incentive of either the full payment increase amount or the calculated total allowed charge amount, whichever is the lesser amount.

EXAMPLE:  
For 2011, if an EP who has predominantly furnished services in a geographic HPSA receives the maximum non-HPSA incentive payment of $18,000, the will receive a payment limit increase of $1,800. 

Scenario 1:  If this EP has $30,000 in total allowed charges for 2011, their calculated allowed charge amount would be $4,500.  This amount exceeds the full payment increase amount of $1,800.  Therefore, the EP will receive HPSA incentive payment of $1800.

Scenario 2:  If this EP has $25,000 in total allowed charges for 2011, their calculated allowed charge amount would be $750.  This amount is less than the full payment increase amount of $1,800.  Therefore, the EP will receive the calculated allowed charge amount of $750.

Scenario 3:  If this EP has $20,000 in total allowed charges for 2011, their calculated allowed charge amount would be less than $0.  This amount is less than the full payment increase amount of $1,800.  Therefore, the EP will not receive a HPSA incentive payment.

In 2011 CMS made the HPSA eligibility determination using the provider’s office location rather than the place of service for each individual claim.  Payments for 2012 and later will use the place of service in the line item claim to determine HPSA eligibility.

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