EHR and practice management for mental / behavioral health
PIMSY behavioral health EHR penalty

Do You HAVE to Use Electronic Health Records (EHR) for Mental and Behavioral Health?

by Leigh-Ann Renz, 4.4.14

Will I Be Penalized For Not Using Electronic Records?! That depends…

The first question for mental / behavioral health and substance abuse practices is: do you have a prescriber on staff?

If not, your organization does not employ an eligible professional (EP) and therefore doesn’t qualify to participate in the ARRA Meaningful Use programs (MU). See Meaningful Use 2014: Use It or Lose It! for more details about the programs.

If you do have a prescriber on board, and you receive Medicaid and/or Medicare reimbursements, you may qualify!

There are no penalties for not participating in Medicaid MU

CMS offers Meaningful Use programs for both Medicaid and Medicare. If you have EPs that qualify for both, you may only participate in one of the two programs. See our MU Guide to determine which program would fit you better.

There is a penalty for not participating in Medicare MU

If you qualify for the Medicare program and don’t participate in 2014, you may be penalized on future Medicare reimbursements. Medicaid EPs who also treat Medicare patients will have a payment adjustment to Medicare reimbursements starting in 2015 if they do not successfully demonstrate MU. This doesn’t mean that you have to participate in the Medicare program: as long as you’re participating in the Medicaid MU program, you are exempt from the penalties. But if you qualify as an EP for the Medicare program and don’t participate in one of the 2 program options, you will be penalized.

The deadline for the Medicare penalty is 2014: if you are participating in the program for the first time, you must be on a certified EHR by July 1st, 2014. This is because you must report on your 90 day consecutive MU on a 2014 Certified EHR no later than October 3, 2014, to avoid a penalty in CY 2015. In order to report for 30 days prior to the attestation deadline, you have to be using the system by July 1st, 2014. Click here for CMS details.

What constitutes participation!?

Participation means demonstrating meaningful use via a MU certified electronic health records (EHR) system, also known as electronic medical records, or EMR. Essentially, you must report on a 3 month period for each year of participation, showing that your practice is using certified software in a way that meets CMS criteria. Contact us for more information.

So what happens if I don’t participate?

The choice to participate in the Medicare incentive program is still up to you as a provider / practice and most likely correlates to how much of your revenue is Medicare-based. There are lots of valid reasons to use an EHR, separate from fear of having your incentives dinged, but if you’re not ready for an electronic system, you don’t have to participate in MU: see What You Should Know About the EHR Mandate for details.

The important thing to consider is that, if you choose not to participate, your Medicare reimbursements will be reduced by 1% in 2015, 2% in 2016 if you’re still not able to demonstrate MU, and 3% in subsequent years.

2 important things to be aware of:

1) The money doesn’t belong to the practice – it belongs to the provider! Be sure to have your EPs sign a letter of understanding that assigns the incentive funds to the organization for all 6 years of the program. See Meaningful Use Funds: Whose Money Is It Anyway!? for more information.

2) While the deadline to avoid the Medicare penalty is applied to your 2015 payments, if this is your first year of participation, you must be using a certified EHR by July 3rd, 2014 to avoid the penalties! This is because you must achieve MU no later than the 3rd quarter of 2014 and attest no later than 10/1/14.

For Medicaid, the only deadlines are for the year: ie, 12/31/14 is the end of the 2014 reporting period for EPs.

Is PIMSY MU certified? Can I use it to avoid the penalties?

Yes, PIMSY Platinum 5.0 is Meaningful Use certified and does qualify you for the Meaningful Use incentives (and penalty avoidance). Contact us for details about getting started on PIMSY Platinum 5.0.

If you’re already a PIMSY client and aren’t sure which PIMSY plan you’re using, let us know. Moving between the plans is seamless, and is a simple upgrade to Platinum if you’re not already on that plan.

See Are EMRs Required for Mental Health for more info.

Update 12/22/14: apparently, there are laws in some states, such as MN, for “all healthcare providers” to be on an EHR by a particular date in 2015. (This includes solo practitioners and small practices!)

However, there are no penalties for non-compliance, and the word on the street is that many practices are simply refusing. Looking toward the future: SAMSHA has a new strategic plan for 2015-2019, which includes the goal of getting every behavioral health and substance abuse provider on an EHR by 2019! We look forward to continue being a resource for your EHR journey.

Leigh-Ann Renz is the Marketing and Business Development Director of PIMSY EHR

Leigh-Ann Renz is the Marketing & Business Development Director of PIMSY EHR. For more information about electronic solutions for your practice, check out Mental Health EHR.

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