Who Qualifies for the Maryland State-Regulated Payor EHR Adoption Incentive?

Beginning October 21, 2011, EHR adoption incentives are available to both hospital owned and non-hospital owned primary care practices in Maryland who adopt an EHR that is certified by an Office of the National Coordinator (ONC) – Authorized Testing and Certification Body (yes, the Medical Mastermind EMR solution qualifies).  Primary care practices include family, general, geriatric, internal medicine, pediatric, or gynecologic practices.  To determine if your EHR system and version is certified, please visit ONC’s Certified Health Information Technology Products List.

What Incentive is Available?

The State-Regulated Payor EHR Adoption Incentive is a one-time cash incentive or an incentive of equivalent value agreed upon by the primary care practice and payor that an eligible primary care practice can receive from each payor. Practices are eligible to receive a Base Incentive up to $7,500 and an Additional Incentive up to $7,500 for a total maximum monetary value of $15,000 per practice per payor. Incentives of equivalent value include: specific services; lump sum payments; gain-sharing arrangements; rewards for quality and efficiency; in-kind payments; or other items or services that can be assigned a specific monetary value.

Base Incentive

The Base Incentive is calculated by the number of payor members treated by the practice based on a per member amount. Incentives are calculated at $8 for each Maryland resident on the practice panel who is a member of the payor at the time a practice makes a request for the incentive payment.  In cases where the payor does not assign a primary care provider, the patients enrolled with that payor who have been treated by the practice in the last 24 months will qualify.

Additional Incentive

An Additional Incentive may be available to practices that have achieved one of the following in the immediate 90 days prior to submitting the payment request:

1) Contracts with a State Designated Management Service Organization (MSO) or MSO in Candidacy Status for EHR adoption or implementation services,

2) Demonstrates advance use of EHRs, or

3) Participates in the payor’s quality improvement outcomes initiative and achieves the performance goals as established by the payor.

The payor to which the practice applies will determine a practice’s eligibility for additional incentives based on the information provided by the practice within an application and payment request.

How do Practices Apply for the State-Regulated Payor EHR Adoption Incentive?

1. Submit an Application

Eligible practices can submit the State-Regulated EHR Adoption Incentive Application (download this application below), including required documentation, between October 21, 2011 and December 31, 2014.  The practice should submit an application to each state-regulated payor with which it does business.  State-regulated payors required to participate include:  Aetna, CareFirst BlueCross BlueShield, Cigna HealthCare Mid-Atlantic, Coventry Health Care, Kaiser Permanente, and United Healthcare, Mid Atlantic Region.  The payor will issue an acknowledgment letter to the practice within 90 days of receiving the application.

State-Regulated Payor EHR Adoption Incentive Application

2. Requesting the Base Incentive and Additional Incentive

In order to request the EHR adoption incentive, eligible practices can submit the State-Regulated EHR Adoption Incentive Request Form (download this payment request below), including required documentation, to each payor it submitted an application.  Eligible practices may submit the payment request no earlier than six months after submitting their application, and no later than December 31, 2014. Practices have the option to request the Base Incentive and theAdditional Incentive at the same time or request the Additional Incentive in a subsequent payment request. Payors must process and pay in full the payment request within 90 days of receipt and will notify practices of the incentive amount, and indicate the method and over what time period the incentive will be provided to the practice.

State-Regulated Payor EHR Adoption Incentive Payment Request Form

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