The Centers for Medicare and Medicaid Services (CMS) provide incentive payments to eligible providers (EP) who give care to Medicaid and Medicare patients and who adopt electronic health records (EHR) systems in their practices and health care organizations or facilities. The EHRs, however, must meet certain standards set forth by the Health Information Technology for Economic and Clinical Health Care (HITECH) Act under the law enacted in the American Recovery and Reinvestment Act (ARRA). These standards include:
- Meaningful use (MU) adoption
- Interoperable data programming and data management for health information exchange (HIE) capabilities between hospitals, laboratories, doctor's offices, etc.
- EHR security
As of 2011, eligible providers (EP) can receive up to $44,000 over the course of five years for incentive payments if they demonstrate upgrades to existing EHR systems, EHR system implementations or plans for implementation. In order to receive the maximum amount of incentive payments, EHR systems should be developed sooner rather than later. Incentive payments can be used to hire an outside vendor for EHR implementation, or new or additional in-house IT staff. Public universities and community colleges are also granted incentive payments in order to educate new IT staff through the Program Assistance for University-Based Training (UBT).
The deadline for EHR implementation is 2015, but many believe this deadline will need to be extended.
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CMS is the Centers for Medicare & Medicaid Services, which is the U.S. federal agency that assists in providing health insurance through Medicare, Medicare Advantage, Medicaid, the Children's Health Insurance Program (CHIP), and the Health Insurance Marketplace. With more than 100 million beneficiaries currently enrolled in CMS health insurance programs, it is imperative to understand how to work with the federal agency for your medical billing practice.
The Centers for Medicare & Medicaid Services administers major healthcare insurance programs in the US, along with a focus on collecting and analyzing data. They produce research reports that are aligned with their dedication to supporting better healthcare systems with improved health care and wellness programs and accessibility.
President Lyndon B. Johnson signed Medicare into law in 1965, as a medical care program. Initially, the Social Security Administration (SSA) administered the program under the Department of Health, Education, and Welfare. In 1977, the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS).
The agency has expanded quite a bit in its scope and coverage since President Johnson first established those initial medical care programs. With all the rate changes, exceptions, reporting, and other requirements over the last year, it’s more important than ever to consult with TempDev to determine appropriate provider solutions, to ensure that you’re current on your regulatory requirements, and to get strategic advice on how to plan future initiatives.
The Centers for Medicare (CMS) administers the following:
CMS not only administers healthcare programs but is also tasked with determining whether healthcare providers and facilities have successfully implemented healthcare IT programs and are compliant with the rules. They can set reimbursement rates for healthcare providers based on their use of healthcare IT programs as set forth in MACRA & HITECH.
TempDev offers the support and tools you need to ensure you’re operating your medical organization to peak efficiency. Many of the most recent CMS policy changes were put in place to reduce the cost and complexity of the healthcare system. The goal is to make it easier for providers to stay in compliance with the various regulations that Congress has implemented.
If you are an organization that participates in Medicare Advantage, your star rating makes a significant difference when it comes to reimbursement and patient enrollments. It also means that you’re required to submit quality reporting on relevant data. TempDev can help you optimize your NextGen EHR to improve your quality scores.
- You can regularly review how your doctors are progressing toward quality measures.
- You can use TempDev’s Quality Measure Dashboard to highlight the gaps in care with HEDIS and other quality programs.
- You can also implement business intelligence with NextGen EHR to better understand how to improve the health of your patient population.
The Office of the National Coordinator for Health Information Technology (ONC) works with CMS. The ONC approves certified healthcare IT systems, which are essential for regulatory, security, and privacy regulations under the Cures Act, MACRA, HITECH, & HIPAA. Healthcare IT has increased in importance over the last few years, as more hospitals and healthcare organizations are transitioning to electronic healthcare records (EHRs) and electronic medical records (EMRs).
ONC has been instrumental in spearheading the successful adoption and implementation of EHRs by doctors and medical staff at hospitals and medical facilities across the US. ONC now estimates that 96% of hospitals have established certified and federally tested EHR systems, which has already supported payouts to the tune of more than $35 billion to hospitals and doctors. Of course, there’s still more work to be done, since complete interoperability is the goal, which would ensure high-quality care, patient safety, and lower costs for healthcare.
TempDev’s team of NextGen & CMS experts support you in meeting regulatory requirements to be successful in both revenue cycle management and quality initiatives. TempDev supports your need for custom automation, configuration, dashboards, remote patient monitoring, telehealth, and workflow redesign for CMS. You'll find the tools and resources you need, with top tips and tricks that will ensure your success even as your needs change under the pressures.
It’s often challenging to keep up with the transformations in the healthcare industry, which is why TempDev’s team of experts is standing by to consult with you and help you to better understand the policy changes, how it has affected revenue and compliance, and how you can satisfy CMS regulations and requirements. Your goal continues to be to protect your staff, doctors, and patients while providing quality care, affordable healthcare pricing, and flexible care options.
Contact us here or by calling us at 888.TEMP.DEV to get the help you need with the Centers for Medicare & Medicaid Services requirements.
The federal agency that runs the Medicare, Medicaid, and Children's Health Insurance Programs, and the federally facilitated Marketplace. For more information, visit cms.gov.
The Centers for Medicare & Medicaid Services (CMS) is part of the U.S. Department of Health and Human Services. CMS oversees many federal healthcare programs, including those that involve health information technology such as the meaningful use incentive program for electronic health records (EHR).
Reimbursement and regulatory functions
In addition to Medicare (the federal health insurance program for the elderly) and Medicaid (the federal needs-based program that helps with medical costs), CMS administers the Children's Health Insurance Program (CHIP), the Health Insurance Portability and Accountability Act (HIPAA) and key portions of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) law.
MACRA includes programs such as Merit-Based Incentive Payment System (MIPS) in which physicians and healthcare organizations are reimbursed based on their scores on healthcare quality and patient satisfaction measures. The approach is also known as value-based reimbursement. CMS also administers alternative payment models (APMs) for healthcare providers such as bundled payments for groups of healthcare organizations, and accountable care organizations, which are reimbursed based on positive medical outcomes.
Since passage of the Health Information Technology for Economic and Clinical Health Act in 2009, CMS has been charged with running the meaningful use program, which is in its final phase with nearly $30 billion of incentive funds having been paid out to healthcare providers.
Under meaningful use, and now the MIPS part of MACRA, CMS determines whether healthcare providers have successfully used health IT systems, and sets Medicare and Medicaid reimbursement rates for healthcare providers that use federally certified health IT systems.
ONC-affiliated agency
The Office of the National Coordinator for Health Information Technology (ONC), another Health and Human Services agency that works closely with CMS, is responsible for approving certified health IT systems and updating health information privacy and security regulations under HIPAA.
Meaningful use has been credited for driving the widespread adoption of EHRs among hospitals and physicians. As of 2015, ONC reported that 96% of nonfederal acute care hospitals were using certified EHR systems. At the end of 2015, 56% of office-based physicians were using certified EHRs.
History of CMS
After Medicare and Medicaid were established in 1965, the Social Security Administration -- through the then Department of Health, Education and Welfare -- administered federal health programs.
In 1977, the former Health Care Financing Administration (HCFA) took over administration of Medicare and Medicaid. In 2001, HCFA became CMS.