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%.
Effective April 2013, Incentives are reduced by 2% due to sequestration
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 or 2016 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.
Medicare MU Penalties
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.
Payment Year and Incentive
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.