CMS Incentive Program Eligibility

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
  • Chiropractor

The Medicare EHR Incentive Program for eligible professionals started in 2011 and will continue through 2016. Depending on the first year they participate, eligible professionals can participate for up to 5 years throughout the duration of the program. The last year to begin receiving eligible incentives in the Medicare EHR Incentive Program was 2014.

  • To qualify for Medicare EHR incentive payments, Medicare eligible professionals must successfully demonstrate meaningful use for each year of participation in the program.
  • Incentive payments are made based on the calendar year. The reporting period for the first year is any 90 continuous days during the calendar year. The reporting period for all subsequent years is the entire calendar year.
  • For calendar years 2011–2016, eligible professionals who demonstrate meaningful use of certified EHR technology can receive up to $44,000 over 5 years under the Medicare EHR Incentive Program. See the payment table below for more information.
  • To receive the maximum EHR incentive payment, Medicare eligible professionals must begin participation by 2012.
  • Important! For 2015 and later, Medicare eligible professionals who do not successfully demonstrate meaningful use will have a payment adjustment to their Medicare reimbursement. The payment reduction starts at 1% and increases each year that a Medicare eligible professional does not demonstrate meaningful use, to a maximum of 5%.
  • Medicare eligible professionals who also qualify as a Medicaid eligible professional must choose between the Medicare and Medicaid incentive programs when they register. Not sure which program to register for? Find more information in the EHR Incentive Programs Overview page.

Medicaid eligible professionals and providers who are not eligible to participate in the Medicare and Medicaid EHR Incentive Programs will not be subject to payment adjustments. However, Medicaid eligible professionals who also treat Medicare patients will have a payment adjustment to Medicare reimbursements starting in 2015 if they do not successfully demonstrate meaningful use.

Who is an Eligible Professional under the Medicaid EHR Incentive Program?

Eligible professionals under the Medicaid EHR Incentive Program include:

  • Physicians (primarily doctors of medicine and doctors of osteopathy)
  • Nurse practitioner
  • Certified nurse-midwife
  • Dentist
  • Physician Assistants who practice in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) 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 of the following criteria:

  • Have a minimum 30% Medicaid patient volume
  • Have a minimum 20% Medicaid patient volume, and is a pediatrician
  • Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals

The Medicaid EHR Incentive Program is offered and administered voluntarily by states and territories. States can start offering their program to eligible professionals as early as 2011. The program continues through 2021. Eligible professionals can participate for 6 years throughout the duration of the program. The last year to begin participation in the Medicaid EHR Incentive Program is 2016.

  • To qualify for Medicaid incentive payments, Medicaid eligible professionals must adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in the first year of participation, and successfully demonstrate meaningful use in subsequent participation years.
  • For calendar years 2011–2021, participants can receive up to $63,750 over 6 years under the Medicaid EHR incentive program. EHR incentive payments are made by the state based on the calendar year. See payment table below.
  • Medicaid eligible professionals who also qualify as Medicare eligible professionals must choose between the Medicare and Medicaid EHR Incentive Programs when they register. Not sure which program to register for? Find more information in the Overview page.
  • Medicaid eligible professionals and providers who are not eligible to participate in the Medicare and Medicaid EHR Incentive Programs will not be subject to payment adjustments. However, Medicaid eligible professionals who also treat Medicare patients will have a payment adjustment to Medicare reimbursements starting in 2015 if they do not successfully demonstrate meaningful use.
  • The New Hampshire Medicaid Electronic Health Record (EHR) incentive program is working under the Federal Centers for Medicare and Medicaid Services (CMS) guidelines. Please visit http://www.dhhs.nh.gov/ombp/ehr/index.htm. for additional details.

The achievement to successfully reach Stage 1 Meaningful Use was the result of a total commitment by every department at Cottage, and the pivotal assistance of the Regional Extension Center of NH.

Director of Management Information
Cottage Hospital

The additional support and funding from CMS and the RECNH has helped justify and expedite our IT progress, while leveraging EHR technology has allowed us to do things we never would have been able to do in a paper world. As a result, we are able to know our patients better and make knowledgeable, quicker clinical decisions that ultimately help lead to safer and better quality care.

David Briden
Chief Information Officer
Exeter Health Resources

In my tiny family practice, the adoption of the EHR and attesting to meaningful use took six months start to finish. With the REC’s assistance, we went through it pretty effortlessly.

Dr. Robin Hallquist
Twin Mountain, NH

Did You Know?

The Centers for Medicare and Medicaid Services established meaningful use criteria to encourage widespread adoption of EHRs with the goal of improving healthcare quality and efficiency.

For providers that qualify as a priority primary care provider, there is no fee associated with RECNH services. Other providers are eligible for low cost, fee-for-service consulting.

There is no specific requirement to connect to a HIE to achieve Stage 1 Meaningful Use. In future years, the need for external electronic connections to communicate with providers and patients will become a required component of meaningful use.

RECNH supports a variety of statewide initiatives. We coordinate and collaborate with the Medicaid Electronic Health Record Incentive Program, and the NH State Public Health reporting initiatives. We are an active member of the New Hampshire Health Information Organization (NHHIO) and support the development of safe and secure health information exchange.

Starting in 2015, Medicare-eligible professionals who do not successfully demonstrate meaningful use will have a payment adjustment to their Medicare reimbursement.

RECNH was launched by the Massachusetts eHealth Collaborative (MAeHC) in 2010 with the support of a $6.9 million federal award. RECNH combines MAeHC’s extensive experience with hands-on New Hampshire experience.

To achieve meaningful use, providers need to show they’re using certified EHR technology to improve healthcare quality and efficiency in significant ways that can be measured.

In New Hampshire, 1,000 priority primary care providers have been targeted for REC services. RECNH is here to support them and the state’s 13 qualifying critical access hospitals.

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