Tag Archives: payor programs

Maryland Docs can get up to $90K for EHR adoption from Insurance Payors

Are you receiving all the money available to you? With this state program, you may be entitled to even more, regardless of whether you plan to participate in the federal government’s ARRA stimulus program. Read on for details from our friends at MedChi Network Services, a division of the Marland State Medical Society.

State-Regulated Payor EHR Adoption Incentive Program

Maryland requires state-regulated payors to provide cash incentives to primary care practices for adopting electronic health records (EHRs). Aetna, CareFirst, Cigna, Coventry, Kaiser Permanente, and United Healthcare must provide a one-time payment to family practitioners, general practitioners, internists, pediatricians, geriatricians, and gynecologists. The total incentive will consist of two separate payment categories: Base Incentives and Additional Incentives. The maximum incentive is $15,000 per practice per payor.

Base Incentives

The base incentive derives from the payor’s share of members treated by the practice. It is calculated at $8 per member up to $7,500 and is limited to Maryland residents. Practices calculate the number of members by either counting the total number of members on the practice panel when the payor assigns a primary care provider, or by determining the total number of members treated by the practice in the past 24 months.

Member eligibility is based on enrollment with the payor at the time a practice makes an incentive request. Payors may exclude members from the incentive calculation if that member was previously included in a different practice’s incentive calculation.

Additional Incentives

The additional incentives are awarded to practices that achieve one of three supplementary goals associated with EHR adoption or use within the immediate 90 days prior to requesting an incentive. The amount will equal $7,500. Practices will receive additional incentives for meeting one of the following:

  • Contracts with a state-designated Management Services Organization (MSO) or MSO in Candidacy Status for EHR adoption or implementation services
  • Demonstrate advanced use of an EHR
  • Participate in quality improvement initiatives and achieve established goals

EXAMPLE

Reimbursements for a practice who sees patients from all 6 payors.

Payer     #Patients      $/Patient              Base         Add’l          Total
Cigna               500         x  $8 =          $4,000    + $7,500 =   $11,500
Coventry         100         x  $8 =              $800    + $7,500 =    $8,300
Kaiser                  2         x  $8 =                  $16    + $7,500 =     $7,516
United             937         x  $8 =           $7,500    + $7,500 =   $15,000
CareFirst         100         x  $8 =              $800   + $7,500 =     $8,300
Aetna                 65         x  $8 =              $520    + $7,500 =     $8,020
Total subsidy paid to practice:                                                 $58,636

Application Process

Practices must apply to each payor by submitting an Incentive Application and a Payment Request. The incentive application can by submitted any time before December 21, 2014. The payor will then send an acknowledgement letter, and the payment request can be submitted no earlier than six months after the application was submitted. Payors are required to adjudicate claims within 60 days and may pay out the incentives over a period of 12 months.

MedChi Network Services will work closely with practices to review how these incentives apply to their specific situation and to receive full payment as soon as possible. Contact Morgan Opie, MedChi Network Services Coordinator, at 410-878-9688 or at mopie@medchi.org.