Hospitals, physicians and other eligible professionals—that is, qualifying dentists, podiatrists, optometrists and chiropractors—have been receiving payments since 2011 through the EHR incentive program created by the American Recovery and Reinvestment Act of 2009. Rural clinics have not qualified.
Rural clinics typically bill for Medicare Part A services using the UB-04 form, the standard claim form for Medicare fee-for-service contractors, according to a statement from the sponsors touting today's session. “However, since the qualifying metric in the statute says 'fee schedule' and this is widely interpreted by CMS as the traditional Medicare Part B form, commonly referred to as the 'CMS-1500,' RHCs are precluded from the incentive programs simply due to an administrative technicality,” the sponsors said.
The sponsors say “time is of the essence” for Congress to act on the bill, since 2014 is the last year eligible providers can begin participating in the Medicare EHR incentive payment program.
The Illinois Hospital Association, in an “advocacy alert,” is asking its members to call their congressional representatives in support of the bill to “correct this inequity.” It said about 100 rural clinics in the state are affiliated with Illinois hospitals.
The CMS declined to comment on the legislation, but pointed to a posted response in the “frequently asked questions” section of its website. The EHR incentive payment program was created in the HITECH provisions of the American Recovery and Reinvestment Act.
“Since services provided by eligible professionals while working in (rural health clinics) are not billed under the Part B physician fee schedule, they do not meet the HITECH Act definition of "covered professional services," according to the CMS response. “As the HITECH Act bases the Medicare EHR incentive payment on a percentage of allowed charges for 'covered professional services, services provided in the (clinics) by the eligible professional would not be included in the calculation for the Medicare EHR incentive.”
The CMS points out, however, that EHR incentive payments under Medicaid are “based on a different methodology” so that eligible professionals at regional health centers may qualify “if they, or the whole RHC as a proxy” meet eligibility criteria for that program, chiefly that 30% of its patients are “needy individuals.”
Unlike physicians and other eligible professionals, who must choose between the Medicare or Medicaid EHR incentive programs – they're limited to one or the other, but cannot receive payments under both -- hospitals can double dip, and CMS records show, overwhelmingly, they do. The EHR incentive payment programs have paid out $15.88 billion thus far, CMS data show.
Technically, Schock's bill would enable rural health clinics to cash in on the Medicare EHR incentive program by making clinics eligible to receive incentive payments for the “covered professional services” of the physicians and other “eligible professionals” who work in them. Similarly, the bill also would enable clinics to collect incentive payments from the Medicare e-prescribing and quality reporting programs if services were furnished by eligible professionals.
Schock also included in the bill a “budget neutrality” provision that directs HHS' secretary to deduct the increased cost of the proposal by reducing the EHR incentive payments of others.
This offsetting funding provision has raised the concern with the National Rural Health Association, said David Lee, its government affairs and policy manager. “We support the principle of the Rural Health Clinic Fairness Act, but some NRHA members have concerns about reducing incentive payments to other providers in order to pay for this important fix,” Lee said. “The budget neutrality built in would cause some rural health hospitals to get a reduced payment.”
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