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Medisoft Market Leading Practice Solutions
    
Physician Incentive Program
Medicare incentive program uses a part B claims method
Medicare Provision
Eligible Professional is a physician as defined in the Social Security Act section 1861:
• a doctor of medicine or osteopathy
• a doctor of dental surgery or of dental medicine
• a doctor of podiatric medicine
• a doctor of optometry
• a chiropractor
To receive Medicare incentive payments, the physician must:
• Not be “hospital-based”
• must submit Medicare part B claims
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?Pays 75% of part B claims up to max
─$3,000 bonus to qualify by
2012
?Requires “meaningful
use” of certified EHR system
?Up to $44k per physician
over 5 years with a 10% bonus for physicians in shortage areas
?Must qualify by 2012 to
receive max
─Reduced incentives for 2013
– 2015
?No payments to providers
after 2016
─2015 – 1% cut in Medicare
payment
─2017 and beyond – 3% to 5%
cut
pending overall market adoption rate
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?Medicare
Advantage (MA) providers qualify for the Medicare incentives using MA
claims instead of part B claims
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Medicaid incentive program uses a net cost method
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Medicaid Provision
The Medicaid HIT Incentive program expands the definition of “eligible professionals” to include:
• certified nurse mid-wife
• nurse practitioner
• physician assistant (under certain circumstances)
To receive Medicaid incentive payments, eligible professionals must:
• Not be “hospital-based;
• Treat a patient population, of which at least 30% receive medical assistance (or 20% if the physician is a pediatrician).
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?Pays 85% of the “net allowable costs”
─Includes system,
implementation, training, maintenance, etc.
?Requires “meaningful
use” by Year 2
─Year 1 can be for adoption
only
?Up to ~$64k per
physician over 6 years
?Must qualify by 2016 to
receive max
?No payments to providers
after 2021
─$340M available until
expended
?Requires 30% Medicaid
patient volume
─20% for pediatricians, but
receive
only 66% of net allowable costs
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“Meaningful use” is largely up to HHS interpretation and has not been completely defined but expected to include:
E-prescribing
Interoperability
Clinical reporting
Secretary may require more stringent measures of meaningful use over time.
Certification requirements are not known yet.
McKesson’s leadership believes that any new certification requirements will be based on the standards that have been adopted by the Certification Commission for Health Information Technology (CCHIT)
McKesson has been deeply involved in this important work and we have well established plans to meet upcoming CCHIT criteria in our future product releases
for more information please visit www.mckesson.com/doctors
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