Home Page > Industry Regulations > Meaningful Use > Reimbursement Reality: Clearing Up the Confusion About Medicare Programs

Reimbursement Reality: Clearing Up the Confusion About Medicare Programs

Fan Favorites

Keeping up with the nuances of the changing reimbursement landscape can be challenging. As the second quarter of 2012 approaches, practices continue to grapple with different aspects of Medicare reimbursement. Some of the most confusing relate to health risk assessments, annual wellness visits, electronic health records and electronic prescribing. To help, here’s a quick overview of those topics, along with links you can reference for more information:

Health Risk Assessment (HRA). The Affordable Care Act (ACA) requires physicians to perform a health risk assessment (HRA) as part of an annual wellness visit for Medicare beneficiaries. Providers from any specialty can perform an HRA as part of an annual wellness visit. There is no specific form associated with the HRA; the Centers for Medicare and Medicaid Services (CMS) leaves it up to the physician on which form to use. For more information about the HRA, visit this link.

The Annual Wellness Visit. If a practice chooses to perform a wellness visit, it can only bill one such visit per patient per year. After a patient’s initial visit, he or she can receive a subsequent visit annually. Note: the annual wellness visit is not the same as an annual physical; Medicare does not cover annual physicals. For more information on the annual wellness visit, visit this link.

Electronic Health Record (EHR) Incentive Program. The Medicare EHR Incentive Program provides bonus payments to eligible physicians that demonstrate meaningful use of certified EHR technology. Currently, participation in this program is voluntary; however, physicians will have to participate in 2014 if they want to avoid a penalty in 2015. (Note: the penalty is for Medicare payments only.) In its second year, the EHR Incentive Program requires participating physicians to demonstrate meaningful use for the entire year (i.e., 365 days). For more information on the EHR Incentive Program, visit this link.

eRx Program. The Electronic Prescribing (eRx) Incentive Program is a reporting program mandated by federal legislation that provides a bonus payment to practices that use electronic prescribing. As of January, the program also applies a negative payment adjustment to those eligible professionals who do not successfully use electronic prescribing for Medicare Part B services. Also new this year, practices cannot collect the incentive payment if they also participate in the Medicare EHR Incentive Program; however, practices still must participate in the Medicare eRx program (if they are eligible) to avoid penalty. For more information about the eRx program, visit this link.

Keeping on top of Medicare rules and regulations can be challenging, but tools and resources are available to help. Have questions or comments? Leave a reply below, and we’ll help you out.