For Healthcare Providers

EHR Incentive Programs

Medicare EHR Incentive Program

EPs can earn up to $44,000 for participating in the Medicare Electronic Health Record Incentive Program and successfully demonstrating Meaningful Use. The program runs from 2011 through 2016. The last year to begin participation is 2014. 


Who is Eligible?

Eligible Professionals (EP) are defined as:

  • Doctors of medicine or osteopathy
  • Doctors of dental surgery or dental medicine
  • Doctors of podiatry
  • Doctors of optometry
  • Chiropractors

 
Only non-hospital based physicians are eligible. Hospital-based providers are those clinicians who perform 90% of their services in a hospital inpatient or emergency room setting.


What Happens if Meaningful Use is Not Achieved?

As of 2015, all Medicare EPs who do not demonstrate Meaningful Use in either the Medicaid or Medicare EHR incentive programs will be subject to a payment reduction in their Medicare reimbursement. The penalty will begin at 1% and will rise by an additional 1% for two years. The maximum penalty thereafter is 5%.


How Are Incentive Payments Calculated?

The formula is based on 75% of allowable charges billed to the Medicare Part B Physician Fee Schedule up to an annual maximum of $24,000. Please consult the table below for the annual incentive payment limits.

Example 1:

If allowable charges billed in year 1 are $4,000
…the incentive payment is $3,000

Example 2:

If allowable charges billed in year 1 are $150,000
…the incentive payment is $18,000

Medicare EHR Incentive Program Payment Schedule
Payment Amounts EP Qualifying for Payment in 2011 EP Qualifying for Payment in 2012 EP Qualifying for Payment in 2013 EP Qualifying for Payment in 2014 EP Qualifying for Payment in 2015
Payment for 2011 $18,000 $0 $0 $0 $0
Payment for 2012 $12,000 $18,000 $0 $0 $0
Payment for 2013 $8,000 $12,000 $15,000 $0 $0
Payment for 2014 $4,000 $8,000 $12,000 $12,000 $0
Payment for 2015 $2,000 $4,000 $8,000 $8,000 $0
Payment for 2016 $0 $2,000 $4,000 $4,000 $0
Total $44,000 $44,000 $39,000 $24,000 $0

 

EPs that predominantly service areas that are designated as a Health Professional Shortage Area (HPSA) will receive an additional 10% above the incentive amount.


Is participation in Several CMS Incentive Programs Permitted Simultaneously?

Physicians can participate in the Physicians Quality Reporting Initiative (PQRI) at the same time as the Medicaid and Medicare EHR incentive programs, provided they meet the eligibility criteria for both. EPs cannot receive incentives in the Medicare EHR incentive program and the e-Prescribing program at the same time.

Medicaid EHR Incentive Program

The Medicaid Electronic Health Record Incentive Program runs from 2011 through 2021. Eligible Professionals (EPs) can participate for 6 years and earn up to $63,750. The last year to begin participation is 2016.

To qualify for the incentives, providers must adopt, implement, or upgrade to certified EHR technology in first year the EP begins the program. After the second year in the program, EPs are required to demonstrate Meaningful Use to qualify for the incentive program. Program participation years do not need to be consecutive; a year can be skipped. The total amount an EP can receive in the program is $63,750.

Medicaid Incentive Program Payment Schedule
Year 1 $21,250
Year 2 $8,500
Year 3 $8,500
Year 4 $8,500
Year 5 $8,500
Year 6 $8,500
Total $63,750

 

Who is Eligible?

Eligible Professionals (EP) are defined as non-hospital based:

  • Physicians
  • Nurse Practitioners (NPs)
  • Certified Nurse Midwives (CNMs)
  • Dentists
  • Physician Assistants (PAs) who lead a Federal Qualified Health Center (FQHC) or Rural Health Clinic (RHC)

 
Hospital-based providers are those clinicians who perform 90% of their services in a hospital inpatient or emergency room setting.


Are There Specific Requirements Needed?

EPs whose patient encounters include at least 30% Medicaid beneficiaries (either managed care or fee-for-service) are eligible for the program. For pediatrics, the threshold is 20% instead of 30%. Those qualifying at the 20% level will receive two-thirds of the incentive payment in any given payment year.

Medicaid Requirements Example Table
Example EPs except Pediatricians (at least 30% Medicaid) Pediatricians (at least 20% Medicaid)
Year 1 $21,250 $14,167

 


What Happens if Meaningful Use is Not Achieved?

As of 2015, there is a penalty for EPs who see Medicare patients but do not demonstrate Meaningful Use in either the Medicaid or Medicare EHR incentive programs. They will be subject to a payment reduction in their Medicare reimbursement. The penalty will begin at 1% and will rise by an additional 1% for two years. The maximum penalty thereafter is 5%.


Does Participating Have Any Impact on Receiving Incentives from Other CMS Programs?

An EP participating in the Medicaid EHR incentive program can still participate in other CMS and State Medicaid programs such as the Medicare CMS e-Prescribing program, the Physicians Quality Reporting Initiative (PQRI), Patient-Centered Medical Home (PCMH) programs, and the New York Medicaid e-Prescribing incentive program.

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