Eligibility Requirements for Professionals
- Incentive payments for eligible professionals are based on individual practitioners.
- If you are a part of a practice, each eligible professional may qualify for an incentive payment if each eligible professional successfully demonstrates Meaningful Use of certified EHR technology.
- Each eligible professional is only eligible for one incentive payment per year, regardless of how many practices or locations in which he or she provides services.
- Hospital-based eligible professionals are not eligible for incentive payments; an eligible professional is considered hospital based if 90 percent or more of their services are performed in a hospital in-patient (Place of Service code 21) or emergency room (Place of Service code 23) setting.
Who is an Eligible Professional under the Medicare EHR Incentive Program?
Eligible professionals under the Medicare EHR Incentive Program include:
- Doctor of medicine or osteopathy
- Doctor of dental surgery or dental medicine
- Doctor of podiatry
- Doctor of optometry
Who is an Eligible Professional under the Medicaid EHR Incentive Program?
Eligible professionals under the Medicaid EHR Incentive Program include:
- Physician (primarily doctors of medicine and doctors of osteopathy)
- Nurse practitioner
- Certified nurse-midwife
- Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant
To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet one (1) of the following criteria:
- Have a minimum 30 percent Medicaid patient volume.*
- Have a minimum 20 percent Medicaid patient volume and is a pediatrician.* or
- Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30 percent patient volume attributable to needy individuals.
*Children’s Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria.
What if I am eligible for both the programs?
Providers eligible for both the Medicare and Medicaid EHR Incentive Programs must choose which incentive program they wish to participate in when they register. Before 2015, an eligible professional may switch programs only once after the first incentive payment is initiated. Most eligible professionals will maximize their incentive payments by participating in the Medicaid EHR Incentive Program.
|Maximum EHR Incentive Payments by Program Based on the First Calendar Year (CY) |
for Which the Eligible Professional Receives Payment ($)
|CY||CY 2011||CY 2012||CY 2013||CY 2014||CY 2015||CY 2016|
Medicare Eligible Professionals may not receive EHR incentive payments under both Medicare and Medicaid.
The amount of the annual EHR incentive payment limit for each payment year will be increased by 10 percent for EPs who predominantly furnish services in an area that is designated as a Health Professional Shortage Area.
- November 30, 2011 – Last day for eligible hospitals and critical access hospitals to register and attest to receive an incentive payment for federal fiscal year (FY) 2011.
- December 31, 2011 – Reporting year ends for eligible professionals.
- February 29, 2012 – Last day for eligible professionals to register and attest to receive an incentive payment for calendar year (CY) 2011.
- February 28, 2013 – Last day for Medicare eligible professionals (EPs) to register and attest to receive an incentive payment for calendar year (CY) 2012. Medicaid EPs should check with their states for their deadline.