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Incentives

Incentives

 

For Medicare participants who first demonstrated meaningful use by 2014, the chart below outlines the maximum incentive payments available upon continued success through 2016. Actual incentive amount is calculated as the lesser of 75% of annual Medicare Part B charges according the Professional Fee Schedule or the amount on the chart. Physicians practicing in a Health Professional Shortage Area (HPSA) are eligible for an additional 10%.

For the provider’s first payment year, he/she must demonstrate meaningful use for any 90-day period. Providers who began their first meaningful use reporting period by October 3, 2012 stand to receive the maximum amount of money.

Providers who first demonstrate meaningful use in 2015 are not eligible for any incentives, however their participation is required to avoid future penalties (“payment adjustments”). Penalties increase over time and are linked to failure to demonstrate meaningful use two years prior.

    Payment Year and Incentive
First Year of Use Total 2011 2012 2013 2014 2015 2016
2011 $44,000 $18,000 $12,000 $8,000 $4,000 $2,000 $0
2012 $44,000 $0 $18,000 $12,000 $8,000 $4,000 $2,000
2013 $39,000 $0 $0 $15,000 $12,000 $8,000 $4,000
2014 $24,000 $0 $0 $0 $12,000 $8,000 $4,000
2015 & on $0 $0 $0 $0 $0 $0 $0

Effective April 2013, Incentives are reduced by 2% due to sequestration

Performance Year Payment Year Penalty
2013 2015 1%
2014 2016 2%
2015 2017 3%
2016 2018 3% or 4%²
2017 2019 3%, 4%, or 5%²

²At discretion of Secretary of HHS, based on national level program participation

For Medicaid participants, the potential incentive is maximum of $63,750, and is paid out over 6 years ($42,500 for pediatricians with 20%-30% Medicaid). The first year does not require demonstration of meaningful use, but can be reimbursement for adoption, implementation, or upgrading to a certified EHR.

There is no penalty for non-participation under Medicaid, but any Medicare revenue generated by a provider who fails to demonstrate meaningful use would be subject to adjustment, as described above.

First Year Total 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
2011 $63,750 21,250 8,500 8,500 8,500 8,500 8,500          
2012 $63,750   21,250 8,500 8,500 8,500 8,500 8,500        
2013 $63,750     21,250 8,500 8,500 8,500 8,500 8,500      
2014 $63,750       21,250 8,500 8,500 8,500 8,500 8,500    
2015 $63,750         $21,250 8,500 8,500 8,500 8,500 8,500  
2016 $63,750           21,250 8,500 8,500 8,500 8,500 8,500

 

Read more about the differences between the Medicare and Medicaid incentive programs.

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