TopMed-Pro Management, Inc.
Medical Practice Management & Consulting
NewsWire                                                                                         November 2010
In This Issue
EHR Incentive Programs: FAQ
Is ACO Model the Future?
EHR Incentive Programs: FAQ

What is the first step to ensure receipt of your incentive bonus for your electronic health record (EHR)?

You will need to purchase and implement a certified EHR.


How could you know if your EHR is certified by the Office of National Coordinator for Health Information Technology (ONC)?

Visit the ONC's website for the list of certified EHR vendors at:


Can you participate in both the Medicare and Medicaid EHR incentive programs?

No.  You will need to pick one.


What percent of your practice has to be Medicare in order to qualify for incentives?

Medicare incentives are not based on patient volume.


How will Medicare incentives be given to doctors? Will it be checks, additional payments, or other?

Incentive payments are ties to the individual "eligible professionals" (EP), and not his/her place of service.  Both Medicare and Medicaid EPs will receive a single, consolidate, annual incentive payment.  EPs would be paid electronically.


When do the doctors expect to get payment?

According to CMS, EPs could receive payments as early as May 2011 if they begin reporting meaningful use objectives on January 1, 2011.

"There are so many men who can figure costs, and so few who can measure values"
                  Author Unknown

Office of the Inspector General (OIG) recently determined that 90% of the Medicare claims sampled were coded with the incorrect place of service. View OIG's report by clicking here.


U.S. plans to create massive medical claims database 


AMA adopts new policy on the use of social media



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Is ACO Model the Future?

On March 23, 2010, the health care reform law was passed and it directed CMS to begin pilot projects to test Accountable Care Organization (ACO) projects.  The most prominent of the projects is the Medicare Shared Savings Program which is scheduled to begin by January 1, 2012. That allows physicians to sign up, voluntarily, for ACOs, which must consist of at least 5,000 Medicare patients per ACO, and must run for at least 3 years. 


ACOs are groups of primary care physicians, specialists, ancillary clinicians and hospitals, joined together in either vertically integrated systems or networks that are accountable for improving the quality and affordability of care for a defined patient population.  To encourage providers to join ACOs, there will be bonuses based on the yet-to-be-determined percentage of the savings the ACO generates to CMS, based on its projection of targeted spending by the organization, and the amount of care it actually billed. Quality criteria will also be used to determinHealthCare Networke the bonus. As of yet, there are no penalties for exceeding target spending under the Medicare program.


One thing is for sure, the current fee-for-service system is under attack. Payers are really looking toward value-based payments rather than fee-for-service payments. 


For physicians, joining an ACO could mean not having to sell a practice to a large institution for financial survival, yet have the advantages of a large system.  According to AMA's American Medical News, this would mean that primary care practices may do well in ACO system.  This is described as turning the patient-centered medical home* into a neighborhood.  ACO adds the funding component that the patient-centered medical home model often has lacked.


Watch a video from The New England Journal of Medicine.


*Medical Home, also known as the Patient-Centered Medical Home (PCMH), is defined as "an approach to providing comprehensive primary care... that facilitates partnerships between individual patients, and their personal Providers, and when appropriate, the patient's family". The provision of medical homes may allow better access to health care, increase satisfaction with care, and improve health.

If you are interested to find out more about any of the topics mentioned, please do not hesitate to send us an email at or call us at (888) 549-1713.
Med-Pro Management, Inc.

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