Meaningful Use Objectives, Penalties and Payments

Meaningful Use (MU) is the set of objectives defined by the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs and allows eligible professionals (EPs) and hospitals to earn incentive payments and avoid penalties by meeting specific criteria.

The EHR Incentive Program provides incentive payments to EPs as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. EPs who do not comply with meaningful use objectives will also be subject to a payment adjustment (PDF, 216 KB) beginning on Jan. 1, 2015.

While CMS has recognized that the MU requirements are outside the scope of pathology practice, several of the MU criteria relate directly or indirectly to pathology laboratory testing and laboratory information Management. On April 17th McKesson hosted a Webinar titled “Meaningful Use of Electronic Health Records: Dissecting the Impact on Pathology & Laboratory” (PDF, 867 KB).

Pathology Exempt from Penalties

In 2012 when CMS issued the final MU Stage 2 Rule (PDF, 1.2 MB), they acknowledged that the physician specialties pathology, radiology and anesthesiology lack the face to face patient interaction and follow up needed with patients to comply with meaningful use criteria and therefore will not be subject to the penalties. The agency provided relief from automatic penalties that would otherwise apply beginning in 2015 for failure to meet MU requirements.

The Stage 2 Rule also stated that to receive Medicare EHR incentive payments, EPs must have an enrollment record in PECOS. A provider that has an independent laboratory (PECOS code 69) would not be eligible to participate in the EHR Incentive program. PECOS Code 69 is deemed a non-physician code in CMS’s system and therefore would not meet the program eligibility requirements. Thus, since these providers are not eligible for the program, they would not be subject to the payment adjustment

These exemptions are subject to annual review. The College of American Pathologist (CAP) along with the College of Radiology and American Society of Anesthesiology are advocating that CMS to extend these exemptions (see letter (PDF, 102 KB)).

EMR Laboratory Transmission Fees

On April 8, 2014 the OIG released advisory opinion 14-03 (PDF, 138 KB) concluding that payment arrangements between the referring physician, EMR vendor and laboratory described in the opinion “implicates the anti-kickback statute because Referring Physicians are relieved of a financial obligation when they refer laboratory test orders to Requestor.” This advisory opinion addresses an arrangement where the laboratory provider is listed as an “in-network” lab in the referring physician EMR system and other labs are not listed as in-network. The EMR vendor is not charging the referring physician a transmission fee if they transmit orders to a lab that is “in-network” and is charging a transmission fee if the lab is not in-networking.

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About the author

Leigh Polk is Pathology Marketing Specialist of McKesson Business Performance Service.