The Ultimate Question of CMS EHR Incentives

CMS EHR Incentives – Defining ‘Seen by and EP’

Most of the questions I receive about the CMS EHR Incentive Programs fall into fairly predictable categories. Who is eligible? What is the timeline? How do I calculate Medicaid percentage thresholds? Lots of questions about the basic issues related to certified EHR technology and meaningful use.

Once in a blue moon I hear a new question that stops me cold. I had one of those questions today. Here is the scenario. The Eligible Professional is a radiologist who never physically sees patients but does bill Medicare for performing radiographic impressions. Based on CMS guidance (below) we are told the EP has the flexibility to define “seen by the EP” as long as at least some of the services they render for patients are designated as “seen by the EP”.

So here is the question: Can the radiologist develop an incentive strategy in which they designate some uncommon discrete service as meeting the definition of “seen by the EP”? Maybe they bill for 10,000 impression but intend to claim based on the CMS guidance (“classifies at least some of the services they render for patients as “seen by the EP”) some service that might only occur 10 times during the reporting period. So they bill Medicare for 10,000 impression of unique patients but only document 10 patients in their EHR. This scenario does not meet the spirit of the incentive program but that is not the question. The question is: Can a specialist who does not physically see a patient adopt this strategy and successfully attest and receive Medicare EHR incentives? Your answer?

CMS Guidance: All cases where the EP and the patient have an actual physical encounter with the patient in which they render any service to the patient should be included in the denominator as seen by the EP. Also a patient seen through telemedicine would still count as a patient “seen by the EP.” However, in cases where the EP and the patient do not have an actual physical or telemedicine encounter, but the EP renders a minimal consultative service for the patient (like reading an EKG), the EP may choose whether to include the patient in the denominator as “seen by the EP” provided the choice is consistent for the entire EHR reporting period and for all relevant meaningful use measures. For example, a cardiologist may choose to exclude patients for whom they provide a one-time reading of an EKG sent to them from another provider, but include more involved consultative services as long as the policy is consistent for the entire EHR reporting period and for all meaningful use measures that include patients “seen by the EP.” EPs who never have a physical or telemedicine interaction with patients must adopt a policy that classifies as least some of the services they render for patients as “seen by the EP” and this policy must be consistent for the entire EHR reporting period and across meaningful use measures that involve patients “seen by the EP” — otherwise, these EPs would not be able to satisfy meaningful use, as they would have denominators of zero for some measures.

Jim Tate is a nationally recognized expert on the CMS EHR Incentive Program, certified technology and meaningful use and author of The Incentive Roadmap® The Meaningful Use of Certified Technology: Stage 1.

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