ARRA EHR Stimulus Payments Under Medicare

UPDATE: Many of you will find my presentation on the ARRA EMR Simulus money of interest.

There’s been a lot of talk (including myself) about the EHR stimulus money. It seems like meaningful use has taken the cake with most of the discussion with certified EHR taking a cozy second place. What I haven’t seen very much of is some practical analysis of the EHR stimulus money and the amount of money various practices will receive. So, I’m going to try to do my part to create some of this practical EHR stimulus money content.

I’m sure that most people have seen a chart like this one describing the $44,000 of EHR stimulus money you can receive from ARRA:

Source: http://hitanalyst.files.wordpress.com/2009/02/hitech2.jpg?w=500&h=234
Source: http://hitanalyst.files.wordpress.com/2009/02/hitech2.jpg?w=500&h=234

Basically, the schedule shows you that you can earn UP TO $18,000 in 2011 (assuming of course that you can show “meaningful use” on a “certified EHR”). What hasn’t been discussed is how many doctors will be eligible for the full $18,000 in stimulus money and how many would only be eligible for $10k or $5k in stimulus money and how much allowable Medicare charges you’ll need to have to receive the full reimbursement.

The EHR stimulus Medicare payments will be paid based on 75% of the submitted allowable charges. For example, a doctors office which has allowable Medicare charges totally $24k or more will be eligible to receive the full $18k in EHR stimulus money. A clinic with $13.3k in allowable Medicare charges would only be eligible for $10k in EHR stimulus money. You can do the math for your own clinic.

Maybe this is a non issue for most clinics. I don’t know. I’ve never seen any published average reimbursement rates for a doctor. $24k doesn’t seem like a lot of Medicare reimbursement, but certainly there are some doctors who are under that amount. Later today I’ll post a poll so we can get a better idea of the average reimbursement rates for a doctor.

What’s most important is for people to know that they’ll only be getting 75% of their Medicare allowable charges up to the cap.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

16 Comments

  • I don’t believe your numbers are correct for Adopt Beginning 2014. From reading the Act, I believe it is 2014 – $12,000, 2015 – $8,000 and 2016 – $4,000.

  • Hi Brian,
    I’ve checked 2 sources and they both say the same as what’s listed above. I’ll check on it more later tonight and correct it if I find something more authoritative. Thanks for checking it and please feel free to link me to any other differing details.

    The principle of 75% of medicare reimbursement should apply regardless of the cap.

  • Thanks John,

    After rereading, perhaps I am reading too much into it. ths language is as follows:

    and such year.
    ‘‘(ii) AMOUNT.—Subject to clauses (iii) through (v),
    the applicable amount specified in this subparagraph
    for an eligible professional is as follows:
    ‘‘(I) For the first payment year for such professional,
    $15,000 (or, if the first payment year for
    such eligible professional is 2011 or 2012, $18,000).
    ‘‘(II) For the second payment year for such
    professional, $12,000.
    ‘‘(III) For the third payment year for such
    professional, $8,000.
    ‘‘(IV) For the fourth payment year for such
    professional, $4,000.
    ‘‘(V) For the fifth payment year for such professional,
    $2,000.
    ‘‘(VI) For any succeeding payment year for
    such professional, $0.
    ‘‘(iii) PHASE DOWN FOR ELIGIBLE PROFESSIONALS
    FIRST ADOPTING EHR AFTER 2013.—If the first payment
    year for an eligible professional is after 2013, then
    the amount specified in this subparagraph for a payment year for such professional is the same as the
    amount specified in clause (ii) for such payment year
    for an eligible professional whose first payment year
    is 2013.

    I may have initially read it as (II) vs (ii) (which includes I through VI) so perhaps I am the one who is incorrect.

  • Thanks for keeping me honest Brian. I think the chart above is right. Thanks for going directly to what’s in the ARRA HITECH act and copying it here.

    Still is amazing to think you only lose $9k if you wait until 2013 to implement an EHR. Not all that much really to see how things go for the early adopters.

  • […] I knew that it was only a matter of time before someone put together an EHR stimulus calculator and I finally found one here. The basic idea is you input your details and then it calculates how much EHR stimulus money you qualify (under the Medicare side of the stimulus money). I think that a calculator like this is important since the amount of EHR stimulus money you get depends on the amount of allowable Medicare charges. […]

  • Is anyone aware how the incentive money will be disbursed? I was assuming payment would be sent in the form of a check for qualifying meaningful users, but have recently read that incentives will be paid to physicians by increasing their Medicare reimbursement by 2%. The wording in the newsletter I have states, “bearing in mind that the incentives are paid out by a 2% increase in Medicare reimbursement, this means that for a physician to get the maximum benefits of say $18,000 in one year, they need to collect at least $900,000 during the time when the 2% incentive is in force”.

    If I understand this right we could easily qualify for the incentives but never be able to recoup the full amount if its only paid out in a 2% increase to our Medicare allowable reimbursement.

    Thank you for any input you may have.

  • Hi TM:

    The 2% reimbursement I believe the newsletter is referring to is the E-prescribe incentive valid in 2011 (up from 1%).

    The Hitech incentive is different (although somewhat related in that it is ANOTHER type of “pay for performance” incentive). Hitech will pay you 18,000 in the form of an additional medicare reimbursement (90 day reporting period in stage 1, meeting the MU criteria and using a certified product)

    Hope this helps

    T.J.

  • TM,
    Looks like that link is confusing the 2 incentive programs. The HITECH act which uses meaningful use is 75% of Medicare allowable charges paid as a one time payment once you’ve reached the max amount.

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