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Information for Providers

Medicare & Medicaid Eligible Providers

Electronic Health Records (EHR) incentive payments will be open to eligible Medicare and Medicaid hospitals and health care professionals. The Medicare and Medicaid programs are similar but differ in eligibility requirements, incentive payment timing, payment amounts and payment structures.

Based on the current proposed rule, under Medicaid, eligible providers have the option to earn incentives for the first payment year through the adoption, implementation or upgrade of certified EHR technology. Medicaid providers do not have to demonstrate meaningful use in the first year otherwise the progression is the same.  Medicaid eligible professionals include: physician (MD, DO), dentist, certified nurse mid-wife, nurse practitioner and physician assistant if they are practicing in a Rural Health Clinic (RHC) or a Federally Qualified Health Center (FQHC) led by a physician assistant. These eligible professionals need to be non-hospital based professionals. Hospitals can qualify if certain Medicaid patient volumes are met for acute care and children. Providers who are not eligible are: behavioral health hospitals and professionals (including MDs), nurses, lab techs, chiropractors.

Based on the current proposed rule, Medicaid eligible professionals must have 30% Medicaid patient volume. A minimum of 30% of all patient encounters have to be attributable to Medicaid over any continuous 90 day period within the most recent calendar year prior to reporting. There are two exceptions: pediatricians must have 20% Medicaid patient volume and Medicaid eligible professionals in a FQHC or RHC (50% of their encounters over a 6 month period in the most recent calendar year) must have a minimum of 30% patient volume (over a 90 day period) attributable to “needy individuals.”

Providers must choose to participate in only one program; Medicare or Medicaid. Providers serving populations in more than one state can participate in only one state. Eligible hospitals may participate in both programs simultaneously.