Medicaid EHR Incentive Program

Who qualifies to participate?

You qualify to participate if any of the following applies to you:

  1. 30% of patient volume is Medicaid patients
  2. Pediatricians qualify if 20% of patient volume is Medicaid patients, but at a reduced incentive
  3. For providers practicing predominately in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) and have a minimum 30% patient volume attributable to needy individuals (Medicaid, CHIP, Sliding Scale, Charity Care)
  • Medicaid providers cannot participate in both the Medicare and Medicaid EHR Incentive Programs like Medicaid hospitals.
  • The incentive program began in 2011 and will run through 2021. The last year that a provider can participate is 2016.
  • The Merit-Based Incentive Payment System (MIPS) does not currently impact or make changes to the Medicaid EHR Incentive Program. MIPS will impact providers participating in the Medicare EHR Incentive Program beginning in CY 2017.
     
    Read more about the Merit-Based Incentive Payment System (MIPS)

How to Calculate Medicaid Patient Volume:

Medicaid patient volume is determined by the following calculation for any 90-day period in the preceding calendar year:

Total Medicaid Patients Seen × 100 = Percentage
Total Patients Seen

If Medicaid patient volume is 30% or more (or 20% for Pediatricians), you qualify to participate in the Incentive Program.

Incentive Payment and Meaningful Use Demonstration Timeline If You Have Not Demonstrated Meaningful Use in Previous Years

Medicare Penalties Begin in 2015

2016 Modified Stage 2 of Meaningful Use

2017 Modified Stage 2 of Meaningful Use

If You Have Demonstrated Meaningful Use in Previous Years

Attestation Period