Programs

Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs

EHR Incentive Program
The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. EPs can receive up to $44,000 through the Medicare EHR Incentive Program and up to $63,750 through the Medicaid EHR Incentive Program.

Eligible hospitals and CAHs should visit the Eligible Hospital Information page to learn about the EHR Incentive Programs.

For more information, visit the EHR website and sign up for the weekly listserv messages.

Quality Measurement

Physician Quality Reporting System (PQRS)
PQRS is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals. The program provides an incentive payment to practices with eligible professionals who satisfactorily report data on clinical quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries. The Affordable Care Act makes a number of changes to the Physician Quality Reporting System, including authorizing incentive payments through 2014 and requiring a penalty, beginning in 2015, for eligible professionals who do not satisfactorily report.

For information on how to avoid the 2015 payment adjustment, a list of eligible professionals, and reporting options, please visit the PQRS website.

Hospital Inpatient Quality Reporting (Hospital IQR) Program
The Hospital IQR Program provides a financial incentive to hosptials the successfully report designated quality measures to CMS.  The program provides CMS with data to help consumers make more informed decisions about their health care.  CMS is aligning the Hospital IQR with the EHR Incentive Programs to allow hospitals to submit unified measures through a single submission method.  

Consumers can find information about hospital quality on the Hospital Compare website at:  www.hosptialcompare.hhs.gov

For more information about the program, visit the Hospital IQR Program website.

eRx Incentive Program

eRx Incentive Program
A prescriber's ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care is an important element in improving the quality of patient care. The eRx Incentive Program encourages providers to use electronic prescribing, which will reduce errors in reading handwriting, decrease adverse drug events by making drug-to-drug information more clearly available, and reduce patients' costs by making their coverage information available before an Rx is ordered.

For more information, visit the eRx Incentive Program website.

Administrative Simplification

Administrative Simplification
The Office of E-Health Standards & Services (OESS), an office within (CMS), is responsible for the administrative simplification section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). OESS responsibilities include:

  • Developing regulations for administrative simplification standards, operating rules, identifiers, and code sets
  • Communicating administrative simplification requirements to industry
  • Enforcing administrative simplification requirements

For more information, please visit the HIPAA page on Administrative Simplification.