The Continuing Extension Act of 2010 extended the availability of Medicare and Medicaid incentive payments for the meaningful use of certified electronic health record technology to physicians who furnish substantially all of their services in hospital-based outpatient locations.
On April 15, 2010, the Continuing Extension Act of 2010 (the Act) was passed by the U.S. Congress and signed into law by President Obama. Among other things, the Act extended the availability of Medicare and Medicaid incentive payments for the meaningful use of certified electronic health record (EHR) technology to physicians and certain other health care professionals who furnish substantially all of their services in hospital-based outpatient locations, other than an emergency department.
The EHR incentive program was established under the Health Information Technology for Economic and Clinical Health Act (HITECH Act) as part of the American Recovery and Reinvestment Act of 2009. As originally enacted in 2009, the HITECH Act made "hospital-based eligible professionals" ineligible for the incentives and defined that term to include any professional, such as a pathologist, anesthesiologist or emergency medicine physician, who furnishes substantially all of his or her Medicare or Medicaid covered services to which the incentive program applies in a hospital inpatient or outpatient setting. In a proposed rule issued by Centers for Medicare & Medicaid Services (CMS) on January 13, 2010 (Proposed Rule), to implement the incentive programs, CMS defined "substantially" as 90 percent or more of the applicable covered professional services provided in an inpatient and/or outpatient hospital setting based on the reporting of place of service (POS) codes 21 (Inpatient Hospital), 22 (Outpatient Hospital) and 23 (Emergency Department) on the eligible professional's claims for Medicare reimbursement. Under this interpretation, physicians and other professionals who provide 90 percent or more of their professional services in clinics and other locations designated by a hospital as an outpatient department location for purposes of Medicare reimbursement of hospital facility services, would not have been eligible for EHR incentives, even though a hospital outpatient facility typically needs a separate ambulatory EHR with capabilities (e.g., patient appointment scheduling) that are not included in an inpatient EHR.
The Act's amendment of the definition of hospital-based professionals limits the scope of ineligibility for EHR incentive to only those professionals who furnish substantially all of their services in a hospital inpatient or emergency department setting and, in turn, permits physicians and other eligible professionals who provide substantially all of their professional services in facilities that are hospital-based outpatient department locations to receive Medicare and Medicaid incentives.
The HITECH Act and the Proposed Rule are also discussed in McDermott's White Papers entitled "Economic Stimulus Package: Policy Implications of the Financial Incentives to Promote Health IT and New Privacy and Security Protections " and "HHS Establishes the Initial Pathway for Qualifying for HITECH Act Incentives Dollars for meaningful Use of Certified Electronic Health Record Technology ."
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