Inpatient Facility Coding & Compliance Alert

Stay away from the radar of payment penalties with these tips.

Are you one of the 400,000 eligible providers who have adopted or are meaningfully using EHRs to date, and enjoying the reduction in meaningful use reporting burden on providers? Be aware of payment reductions if you still aren’t meeting the meaningful use (MU) requirements. “The real benefit from these incentives lies with the use of the technology,” explains Duane C. Abbey, PhD, president of Abbey and Abbey Consultants Inc., in Ames, IA. Read on for a low down on the 2015 meaningful use changes.

Enjoy a Drastically Shortened Reporting Period

In 2015, CMS responds to providers’ concerns about software implementation, information exchange readiness, and other related concerns. CMS may therefore:

1. Realign hospital EHR reporting periods to the calendar year, which would allow eligible hospitals more time to incorporate the 2014 Edition software in their workflows and better align with other CMS quality programs.

2. Modify other program aspects to match long-term goals, reduce complexity, and decrease providers’ reporting burdens.

3. Shorten the EHR reporting period in 2015 from a full year to 90 days to accommodate these changes.

CMS also proposes to limit the scope of the Stage 3 proposed rule to criteria for MU in 2017 and beyond.

Brace Yourself for Reimbursement Penalties

Unfortunately, these changes won’t mitigate the fact that you’ll face reductions in your Medicare reimbursement if you do not meet the EHR Incentive Program’s MU requirements.

Background: Back in October 2014, CMS extended the hardship exception deadline until Nov. 30, 2014, which allowed you to avoid a payment adjustment in 2015. The incentive structure built into the EHR Incentive Program stated that healthcare providers who fail to meet the meaningful use requirements would face a 1 percent payment adjustment in their 2015 Medicare payments.

Hence, payment reductions began on Jan. 5, 2015, as follows:

• Those who failed to adopt an EHR system and meet the MU requirements in 2014 would face a 1-percent reduction in their 2015 Medicare payments. 

• Physicians who failed to meet both the MU and electronic prescribing program requirements in 2014 face a 2-percent reduction this year. An estimated 285,000 physicians will experience a payment reduction.

• For hospitals, the payment reductions began on Oct. 1, 2014, with about 200 hospitals that failed to participate in the MU program beginning to receive fewer Medicare dollars per patient in 2015.

Hospitals face a 25 percent reduction, with the payment adjustment increasing to 50 percent in 2016.The payment adjustments apply to the percentage increase to the Inpatient Prospective Payment System (IPPS) payment rate.

Looking ahead: The payment adjustments announced by CMS signal that healthcare providers may have a steeper hill to climb in order to meet the meaningful use requirements in later stages. “Obviously, avoiding any reduction in payment is a goal,” declares Abbey. Given CMS’ enforcement of payment adjustments in Stage 1, healthcare providers should brace for challenges from more binding requirements in Stage 2 and Stage 3.