The Medicare and Medicaid Incentives Program

Each office-based physician who uses an ARRA meaningful use certified EHR could receive up to $44,000 in case of Medicare or $64,000 in case of Medicaid in government funding. Office-based physicians practicing in rural or underserved areas would be eligible for up to $48,400 in Medicare incentives. It's important to note that these figures represent the maximum allowable incentives under the Medicare and Medicaid programs, and that physicians may only qualify for either the Medicare or the Medicaid funding, but cannot qualify for both.

The Medicare EHR Incentive Program

The Medicare EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology.

  • Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program. There's an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HPSA).
  • To get the maximum incentive payment, Medicare eligible professionals must begin participation by 2012.
  • Incentive payments for eligible hospitals and CAHs may begin as early as 2011 and are based on a number of factors, beginning with a $2 million base payment.
  • Important! For 2015 and later, Medicare eligible professionals, eligible hospitals, and CAHs that do not successfully demonstrate meaningful use will have a payment adjustment in their Medicare reimbursement.

ARRA Medicare

Courtesy: www.cms.gov

The Medicaid EHR Incentive Program

The Medicaid EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their first year of participation and demonstrate meaningful use for up to five remaining participation years.

  • The Medicaid EHR Incentive Program is voluntarily offered by individual states and territories and may begin as early as 2011, depending on the state. Check with your State Medicaid Agency for more information.
  • Eligible professionals can receive up to $63,750 over the six years that they choose to participate in the program.
  • Eligible hospital incentive payments may begin as early as 2011, depending on when the state begins its program. The last year a Medicaid eligible hospital may begin the program is 2016. Hospital payments are based on a number of factors, beginning with a $2 million base payment.
  • There are no payment adjustments under the Medicaid EHR Incentive Program.

ARRA Medicaid

Courtesy: www.cms.gov

Who all are eligible for incentives?

Medicare:

Any Medicare provider who are 'Eligible Professionals' under the Medicare HIT incentive program are eligible for incentives. 'Eligible professionals' are limited to physicians as defined in the Social Security Act (§1861(r)). This includes:

  • A doctor of medicine or osteopathy
  • A doctor of surgery or of dental medicine
  • A doctor of pediatric medicine
  • A doctor of optometry
  • A chiropractor

To receive Medicare incentive payments, the physician must:

  • Not be hospital-based;
  • Demonstrate meaningful use of a certified EHR; and
  • Submit Medicare Part B claims of at least 133% of the maximum incentive for a program year to qualify for the maximum incentive payment.

Medicaid:

The Medicaid HIT Incentive program expands the definition of 'eligible professionals' to include:

  • Certified nurse mid-wife
  • Nurse practitioner
  • Physician assistant (under certain circumstances)

To receive Medicaid incentive payments, eligible professionals must:

  • Not be hospital-based;
  • Demonstrate meaningful use of a certified EHR; and
  • Treat a patient population, of which at least 30% receive medical assistance (or 20% if the physician is a pediatrician).

Although the incentives are not dependent on the eligible provider being a participating Medicare provider, the incentive amounts available to any provider is the lesser of 133% of their annual billed Medicare Part B charges or the maximum payment specified for the year in the regulations.

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