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Medicare and Medicaid Promoting Interoperability Program Basics

The Centers for Medicare & Medicaid Services (CMS) is renaming the EHR Incentive Programs to the Promoting Interoperability (PI) Programs to continue the agency’s focus on improving patients’ access to health information and reducing the time and cost required of providers to comply with the programs’ requirements. CMS is also in the process of finalizing updates to the programs through rulemaking. For more information, visit the landing page where CMS will publish updates and additional resources as soon as they are available.

Beginning in 2011, the Medicare and Medicaid EHR Incentive Programs were developed to encourage eligible professionals (EPs) and eligible hospitals to adopt, implement, upgrade (AIU), and demonstrate meaningful use of certified electronic health record technology (CEHRT).

As of February 2018, more than 544,000 health care providers received payment for participating in the Medicare and Medicaid PI Programs.

On April 24, 2018 the Centers for Medicare & Medicaid Services (CMS) proposed changes to empower patients through better access to hospital price information, improve the use of EHRs, and make it easier for providers to spend time with their patients. The proposed rule proposes updates to Medicare Payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS).

In addition to programmatic changes, CMS is also proposing to overhaul the Medicare and Medicaid EHR Incentive Programs to focus on interoperability, improve flexibility, relieve burden and place emphasis on measures that require the electronic exchange of health information between providers and patients. To better reflect this new focus, CMS is renaming the EHR Incentive Programs to the Promoting Interoperability (PI) Programs.

2018 Program Requirements

To learn more about program requirements for Medicare in 2018, click here.

To learn more about program requirements for Medicaid in 2018, click here.

Fiscal Year 2019 IPPS LTCH PPS Changes to PI Programs Requirements

  • All eligible hospitals and critical access hospitals (CAHs) who report electronically, the reporting period is one self-selected quarter of calendar year (CY) 2019 data reporting on at least four self-selected clinical quality measures (CQMs) from the set of 16.
  • The submission period will be two months following the close of the CY ending on February 29, 2020.
  • Beginning with the CY 2019 reporting period all eligible hospitals and CAHs will be required to use 2015 edition CEHRT.
  • Reporting periods in 2019 and 2020 for new and returning participants attesting to CMS or their state Medicaid agency would be a minimum of any continuous 90-day period within each CY.
  • For the 2020 reporting period, CMS is proposing to remove eight of the 16 CQMs to be consistent with CMS’ commitment to producing a smaller set of meaningful measures.

Additional Information for EPs Participating in the Medicare PI Program:

  • In 2018, all EPs previously participating in the Medicare PI Program will report on Quality Payment Program requirements. For more information on the Quality Payment Program, click here.
  • Beginning in 2015, EPs who do not successfully demonstrate meaningful use will be subject to a payment adjustment. The payment reduction starts at 1 percent and increases each year that an eligible professional does not demonstrate meaningful use, to a maximum of 5 percent.
  • Additional information on payment adjustments can be found on the Payment Adjustments & Hardship Information page.

Additional Information for EPs Participating in the Medicaid EHR PI Program:

  • The program is administered voluntarily by states and territories, and will pay incentives through 2021. EPs are eligible for incentive payments for six years, and participation years do not have to be consecutive.
  • The last year that an EP can begin participation is 2016. Incentive payments for EPs are higher under the Medicaid PI Payments— up to $63,750 over six years.
  • EPs can receive an incentive payment for AIU CEHRT in their first year of participation.
    • In subsequent years, EPs can receive incentive payments for successfully demonstrating meaningful use.
  • If you qualify for both the Medicare and Medicaid PI Programs, you must choose which program you want to participate in. If you are only eligible for the Medicaid PI Program, you will not be subject to payment adjustments.
  • Medicaid EPs who also treat Medicare patients will have a payment adjustment to Medicare reimbursements starting in 2015 if they do not successfully demonstrate meaningful use.

For information about the PI Programs in previous years, visit the landing page.