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CMS Medicare and Medicaid HER incentive programs: Stage 2 Final Rule

CMS MEDICARE AND MEDICAID EHR INCENTIVE PROGRAMS: STAGE 2 FINAL RULE 

Thursday, August 23, 2012
Contact:

CMS Office of Public Affairs
202-690-6145

or click here for CMS

Rule Provisions

Through the Stage 2 requirements of the Medicare and Medicaid EHR Incentive Programs, CMS seeks to expand the meaningful use of certified EHR technology. Certified EHR technology used in a meaningful way is one piece of a broader health information technology infrastructure needed to reform the health care system and improve health care quality, efficiency, and patient safety. Highlights of the rule’s provisions follow:

Stage 2 Timing

In the Stage 1 meaningful use regulations, CMS established an original timeline that would have required Medicare providers who first demonstrated meaningful use in 2011 to meet the Stage 2 criteria in 2013. The Stage 2 rule gives providers more time to meet Stage 2 criteria. A provider that attested to Stage 1 of meaningful use in 2011 would attest to Stage 2 in 2014, instead of in 2013.   Therefore, providers are not required to meet Stage 2 meaningful use before 2014.   The table below illustrates the progression of meaningful use stages from the first year a Medicare provider begins participation in the program.

1st

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

2012

1

1

2

2

3

3

TBD

TBD

TBD

TBD

2013

1

1

2

2

3

3

TBD

TBD

TBD

2014

1

1

2

2

3

3

TBD

TBD

2015

1

1

2

2

3

3

TBD

2016

1

1

2

2

3

3

2017

1

1

2

2

3

For 2014 only, providers that are beyond the first year of demonstrating meaningful use will have a 3-month quarter reporting period to allow an additional up to 9 months to upgrade certified EHR technology to the 2014 edition.

The final rule reduces some thresholds for achieving certain measures and modifies criteria for exclusions to respond to difficulties commenters identified in implementing certain objectives in certain situations. For example, for some objectives CMS has added exclusions based on broadband availability that allow providers in rural or underserved areas to achieve meaningful use with fewer hurdles. Please click here to read the entire article offered by CMS

In House Vs Annapolis Billing

 

 

 

We calculate a rate that is fair to both your practice and Annapolis Billing Service. There are economies of scale in billing, so the bigger the practice, the lower the rate. Also, the higher the average charge, the lower the rate. The percentage we generally charge a practice is 6.0% of net collections (example percentage used below), but each practice is different and we consider all elements of the practice.

 

Let's look at the cost of performing the billing services for one physician COLLECTING $50,000.00 per month .In this scenario, we will use one billing employee for a single physician. 

 

One Billing Employee for a single physician'

  

In-House

Yearly

Billing company

Yearly

Employee Biller

$33,500.00

Trained Medical Billing Team

Included

 After hours/overtime

 805.00 ( 40 hours  per yr)

Follow-up and appeals team

Invaluable

Health Insurance

$4,800.00

Health Insurance

Included

Vacation time (2 wks)

$1,288.00

No vacation time

Included

Sick Time (5 days)

$644.00

No sick days

Included

Taxes

$2,331.00

No taxes

Included

Software Maintenance

$4,800.00

Software maintenance

900.00

Clearing house, postage and forms

600.00

Clearing house, supplies and postage

Managed

 Centricity PM

 1200.00

Billing software

1200.00

 Denial/Appeals

 invaluable

Management Reports

Included and invaluable

Incentive to be relentless

N/A

Incentive to be relentless

YES

Total Employee and supply Cost for in-house billing.

 

 

$51,255.00

 

 

 

 

Total Savings

Total  Annapolis Billing Service  

 

 

 $11, 055.00 - Time, Money and Headaches

$40,200.00

 

 

 

 

 

Medicare and the Affordable Health Care Act Update

Strengthening Medicare

Cross-posed from healthcare.gov:

Don Berwick, M.D., Administrator of the Centers for Medicare and Medicaid Services

Millions of Americans rely on Medicare for their health care security. But for years, skyrocketing health care costs have threatened the long-term financial health of the program. Many people with Medicare have worried about the long-term solvency of Medicare and whether or not there would be enough funds in the program in the future to pay for care for them and their children.

Thanks to some important new features of the Affordable Care Act, Americans can rest assured that Medicare will continue to be there – better than ever – for our seniors and individuals with disabilities.

Today, the Centers for Medicare & Medicaid Services, released a new report, Affordable Care Act Update: Implementing Medicare Costs Savings, demonstrating just how much – and how fast – important provisions of the Affordable Care Act will improve the financial health of Medicare. In 2010 and 2011 alone, these provisions will save Medicare an estimated $8 billion and almost $418 billion by 2019. These savings will protect the solvency of the Medicare Trust Fund through 2027, extending its life by 12 years.

These new savings will come largely as a result of reducing excessive payments to private health insurance companies, promoting better quality of care, and cutting Medicare waste and fraud through powerful new tools. These tools keep bad actors out of the Medicare program in order to prevent fraud in the first place and enhanced technologies to help law enforcement stop fraud quickly when it does occur.

And there are many important investments in support of innovation for clinicians and health care organizations who are trying every day, as the Centers for Medicare & Medicaid Services is, to make health care better for patients and more affordable at the same time.

There are other actions in the new law that strengthen Medicare by improving the health of those who receive benefits. These include improving outreach and coordination efforts after a patient is discharged from the hospital to prevent unnecessary hospital readmissions and reducing preventable surgical errors.

Many of the programs in the Affordable Care Act are designed to ensure that people with Medicare continue to have access to quality, affordable care. This year, many people with Medicare who have fallen into the Medicare donut hole are receiving a one-time $250 rebate check to help with their drug costs, making sure that financial concerns do not interrupt needed treatment agreed on by a patient and a doctor.

And next year, all people with Medicare will have access to annual wellness visits and other preventive services with no cost-sharing, giving millions of Americans an opportunity to get potentially life-saving screenings. Over time, new reforms will also encourage better coordinated care.

Together, this adds up to a good deal for people with Medicare and taxpayers. If you or someone you love is on Medicare, make sure to check out sections like  here on www.healthcare.gov that talk more about how the Affordable Care Act affects you.