EHR Incentive Programs

With the exception of dually-eligible hospitals, providers can only participate in one of the EHR Incentive Programs—Medicare or Medicaid—each year.  This blog (with the assistance of some CMS resources) will outline key differences between the Medicare and Medicaid EHR Incentive Programs.

Eligible Participants in the Medicare EHR Incentive Program

  • Doctors of medicine or osteopathy
  • Doctors of dental surgery or dental medicine
  • Doctors of podiatry
  • Doctors of optometry
  • Chiropractors
  • “Subsection (d) hospitals” in the 50 states or DC that are paid under the Inpatient Prospective Payment System (IPPS)
  • Critical Access Hospitals (CAHs)
  • Medicare Advantage (MA-Affiliated) Hospitals

Eligible Participants in the Medicaid EHR Incentive Program

  • Physicians (primarily doctors of medicine and doctors of osteopathy)
  • Nurse practitioners
  • Certified nurse-midwives
  • Dentists
  • Physician assistants who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant
  • Acute care hospitals (including CAHs and cancer hospitals) with at least 10% Medicaid patient volume
  • Children’s hospitals (no Medicaid patient volume requirements)

Dually-Eligible Hospitals
If you represent a hospital that meets all of the following qualifications, you are dually-eligible for the Medicare and Medicaid EHR Incentive Programs:

  • You are a subsection(d) hospital in the 50 U.S. States or the District of Columbia, or you are a CAH; and
  • You have a CMS Certification Number ending in 0001-0879 or 1300-1399; and
  • You have 10% of your patient volume derived from Medicaid encounters.
Resources

(Disclaimer: This post is not intended as legal advice nor does it create an attorney-client relationship.)

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