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Medicare & Medicaid 
EHR Incentive Program
Specifics of the Program for 
Eligible Professionals
August 10, 2010
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Today’s Session
This training will cover the following topics:
• EHR Incentive Programs –a Background
• Who Is Eligible to Participate
• How Much Are the Incentives
• What Are the Requirements/Meaningful Use
• What You Need to Participate
• Timeline of the Programs
• Resources to Get Help and Learn More
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What is the EHR Incentive 
Program?
EHR Incentive Programs were established by law
• American Recovery & Reinvestment Act of 2009
• Incentive programs for Medicare and Medicaid
• Programs for hospitals and eligible professionals
• Must use certified EHR technology AND demonstrate 
adoption, implementation, upgrading or meaningful 
use
• Programs differ between Medicare and Medicaid
• Medicare incentive program is federally run by CMS
• Medicaid incentive program is run by States and is 
voluntary
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Who is Eligible to 
Participate?
• Eligibility determined  in law
• Hospital-based EPs are NOT eligible for 
incentives
• DEFINITION: 90% or more of their covered 
professional services in either an inpatient (POS 21) 
or emergency room (POS 23) of a hospital
• Definition of hospital-based determined in law
• Incentives are based on the individual, not the 
practice
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Who is Eligible to 
Participate?
• Medicare Eligible Professionals include:
• Doctors of medicine or osteopathy
• Doctors of dental surgery or dental medicine
• Doctors of podiatric medicine
• Doctors of optometry
• Chiropractors
• Specialties are eligible if meet one of above 
criteria
• EPs may not be hospital-based
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Who is Eligible to 
Participate?
• Eligible Professionals in Medicare Advantage must:
• Furnish, on average, at least 20 hours/week of 
patient-care services and be employed by the 
qualifying MA organization, OR
• Furnish, on average, at least 20 hours/week of patient 
care services and be employed by, or be a partner of, 
an entity that through contract with the qualifying MA 
organization furnishes at least 80% of the entity’s 
Medicare patient care services to enrollees of the 
qualifying MA organization AND
• 80% of professional services are provided to 
enrollees of the MAO
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Who is Eligible to 
Participate?
• Medicaid Eligible Professionals include:
• Physicians
• Nurse practitioners
• Certified nurse-midwives
• Dentists
• Physicians assistants working in a Federally Qualified 
Health Center (FQHC) or rural health clinic (RHC) 
that is so led by a physicians assistant
• EPs may not be hospital-based
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Who is Eligible to 
Participate?
• Medicaid Eligible Professionals must also meet 
one of the three patient volume thresholds:
• Have a minimum of 30% Medicaid patient volume
• Pediatricians ONLY: Have a minimum of 20% 
Medicaid patient volume
• Working in FQHC or RHC ONLY: Have a minimum of 
30% patient volume attributed to needy individuals
• CHIP, sliding scale, free care only count towards 
thresholds if working in RHC or FQHC
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Who is Eligible to Participate?
• Participation in EHR incentive program and other 
Medicare incentive programs
Other Medicare Incentive 
Program
Eligible for HITECH EHR IncentiveProgram?
Medicare Physician Quality 
Reporting Initiative (PQRI)
Yes, if the EP is eligible.
MedicareElectronic Health 
Record Demonstration (EHR 
Demo)
Yes, if the EP is eligible.
Medicare Care Management
Performance Demonstration 
(MCMP)
Yes, if the practice is eligible.The MCMP demo will end 
before EHR incentive payments are available. 
Electronic Prescribing (eRx) 
Incentive Program
If the EP chooses to participate in theMedicare
EHR 
Incentive Program, they cannot participate in the Medicare 
eRx Incentive Program simultaneously in the same 
program year. If the EP chooses to participate in the 
Medicaid
EHR Incentive Program, they can participate in 
the Medicare eRx Incentive Program simultaneously. 
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How Much Are the 
Incentives?
• Medicare Incentive Payments Overview
• Incentive amounts based on Fee-for-Service 
allowable charges
• Maximum incentives are $44,000 over 5 years
• Incentives decrease if starting after 2012
• Must begin by 2014 to receive incentive payments. 
Last payment year is 2016.
• Extra bonus amount available for practicing 
predominantly in a Health Professional Shortage Area
• Only 1 incentive payment per year
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