CMS Requirements for Eligible Professionals

On December 30, 2009, CMS issued a proposal detailing criteria for determining which doctors qualify as “Eligible Professionals” for the “Meaningful Use” of electronic medical records – along with specific guidelines for “Meaningful Use” itself.

The ARRA HITECH Act provides for incentive payments to eligible professionals (EPs) that become meaningful users of certified EHRs. In general, an eligible professional is a doctor of medicine or osteopathy, a doctor of dental surgery or dental medicine, a doctor of podiatric medicine, a doctor of optometry, or a chiropractor legally authorized to practice under state law. A “Qualified Eligible Professional” is one who demonstrates Meaningful Use of a “Qualified EHR” during a specified reporting period.

Highlights of CMS Eligibility Requirements for the HITECH Incentives

• Eligible professionals (EP) may participate in the ARRA HITECH program. EPs are physicians, dentists, nurse practitioners, certified nurse midwives, and physician assistants practicing predominantly in a Federally Qualified Health Center or Rural Health Clinic (FQHC/RHC) directed by a physician assistant.
• EPs must annually meet specific patient volume thresholds, measured by a ratio where the numerator is the total number of Medicare patient encounters over any representative continuous 90-day period in the most recent calendar year and the denominator is all patient encounters over that same 90-day period. 
  • For all EPs except pediatricians, the patient volume threshold is 30%; for pediatricians, the patient volume threshold is 20%.
  • EPs practicing predominately at Federally Qualified Health Center or Rural Health Clinics a minimum of 30% of patient encounters over any continuous 90-day period in the most recent calendar year must have been with “Needy Individuals.”
    • “Needy Individuals” are patients who receive financial assistance from Medicaid or the Children’s Health Insurance Program, individuals provided with charity care, or individuals provided services at reduced cost based on a sliding scale determined by the individual’s “ability to pay.”
• The CMS rule also specifies that entities promoting the adoption of certified EHR technology, such as the Regional Extension Centers (REC), may be designated by states for EPs to voluntarily assign their incentive payments.
  • CMS authorizes the RECs to provide oversight of the business, operational and legal issues involved in the adoption and implementation of EHR and the secure exchange and use of electronic health information between participating providers.
• As a certified Regional Extension Center, NYeC assists EPs with in the selection of certified EHRs, the efficient implementation of the EHRs, staff training and compliance with HIPAA security and patient health information privacy requirements.