LINKS BY SUBJECT

"HITEC" Incentives for Private Practitioners:

The incentives summarized in this page come from the H.R. 1: The American Reinvestment and Recovery Act of 2009, Divisions B, Title IV, Subtitle A,Section 4101.

 

Important: Please Read

Medicare and Medicaid incentives will pay 75% of your claims up to an annual cap. If you do not submit bills to Medicaid or Medicare, you get nothing.

 

There Are Still Lots Of Unknowns

The laws are on the books but the mechanisms to administer them simply don't exist yet. Health and Human Services expects to have the details in place by December, 2009. Productive Practices will update this site as soon as new information becomes available.

 

The Basic Plans

Medicare will pay up to $44,000 per practitioner over 5 years. Medicaid will pay up to $65,000 per practitioner over five years. The planse are separate and practitioners can only participate in one plan. Incentive payments will begin for practitioners activities in calendar year 2011.

 

Each package has a different application process. Each will use its own rules and qualification tests. Neither entity has as yet established hard qualification criteria, application procedures or reimbursement mechanisms. Both payers will require that you prove "meaningful use" of a "certified" EHR (Electronic Health Record) system: in other words, you'll have to prove that you actually exchange data with other health care entities. You'll find more details on each plan below.

 

Other Incentives

Two additional "incentives" are available now: one for practices that e-prescribe, and one for physicians that submit Medicare and/or Medicaid bills electronically. Combined incentives can be as high as $8,000 per practitioner-year. Click the links above to learn more.

 

Who Is A Qualified Practitioner?

MDs, Nurse Practitioners, Nurse Midwives and Physicians Assistants working full time in private practices. Part time clinicans will qualify, but their reimbursements may be subject pro rata reductions based on time worked. Practitioners who split time between hospitals and private practice or between multiple private practices will be capped at $44,000 for his aggregate work. Applications will be checked for double-dipping.

 

Medicare Incentives

Medicare will pay up to$44,000 per qualifying professional in private practice over five years. Practices will be paid up to 75% of each qualifying clinician's approved claims to medicare up to the caps listed in the table below. Other rules follow.

 

* First year maximum payments may change for 2013 & 2014.

•	Practitioners can request payments for up to 5 years. No "first year" requests will be accepted after year-end 2014. No payments will be made after year-end 2016.
•	Incentive payment requests must be made within 60 days of calendar year end.
•	The Department of Health can choose to make lump sum or incremental payments. Payments will be made to doctors from a Federal Supplementary Medical Insurance Trust Fund.
•	Payments will begin in 2011 by the Department of Health or its designee.
•	Practitioners in specialties listed as "Health Professional Shortage Areas" are eligible for an additional 10% over and above the caps. (See a current list.)
•	There is a long list of definitions, proofs and other criteria that may be part of the qualification process. The department of health is still working out the details. Use of e-Prescriptions is one likely criterion.
•	Individual doctor's submissions will be checked to prevent double-dipping.

 

Medicaid Incentives

Medicaid will pay up to$65,000 per qualifying professional in private practice over five years. Practices will be paid up to 85% of each qualifying clinician's approved claims to Medicaid up to the caps listed in the table below. In order to qualify, most physicians will have to show that at least 30% of their patients are on Medicaid.

•	Pay outs will be made over five years. First year maximum payout is $25,000. The maximum payouts for years 2-5 are $10,000 per year.
•	Most practitioners must demonstrate that 30% of their active patients are on Medicaid. Pediatricians and some other specialties that demonstrate a 20% Medicaid patient load will be eligible for reduced payments.
•	Payments will begin in 2012 for activities in calendar year 2011.
•	First year applications will be accepted for activities through 2016. All payments will end after calendar year 2020.
•	Incentive payment requests must be made within 60 days of calendar year end.
•	Payments will be made via State Agencies.
•	Practitioners in specialties listed as "Health Professional Shortage Areas" are eligible for an additional 10% over and above the caps. (See a current list.)
•	There is a long list of definitions, proofs and other criteria that may be part of the qualification process. The department of health is still working out the details. Use of e-Prescriptions is one likely criterion.