The Centers for Medicare & Medicaid Services has confirmed that physicians who assign their reimbursement and billing to a critical access hospital (CAH) under "Method II" are now able to participate in the Medicare incentive program as eligible professionals.
The change, part of the calendar year 2014 Outpatient Prospective Payment System/Ambulatory Surgery Center final rule issued Nov. 27, is an attempt to resolve what many had seen as unfair, since CMS did not have the technical capability to ensure that the physicians' claims were tied to the specific services rendered. As a result, these physicians could not use data from the CAH's UB-04 claims. Method II CAHs are those that elect to receive both a facility payment and a professional payment for outpatient services.
Noting that this is a "special circumstance," CMS has since implemented system changes so that these physicians can participate in the program beginning in 2013.
The maximum payment these physicians will be able to receive is $38,220. They also now are subject to payment adjustments for failing to meet Meaningful Use as of 2015.
The rule also makes some technical corrections to the incentive program regarding cost reporting and definitions.
This is not the first time that the Meaningful Use program has been tweaked to enable providers initially left out to ultimately participate. Rural health centers and Federally Qualified Health Centers have also been added; bills have been introduced in Congress to expand the program further to behavioral health specialists and safety net clinics.
Researchers publishing in August in Health Affairs found that smaller and critical access hospitals were particularly vulnerable to falling behind in Meaningful Use of EHRs due to their low patient volume, lack of resources to invest in EHRs, difficulty recruiting qualified IT personnel and trouble finding a suitable EHR vendor.
To learn more:
- read the fact sheet
- here's the rule