Maryland Electronic Health Record Incentive Program
Who is Eligible for Electronic Health Record Incentive Payments?
Individual providers choosing to participate in the Medicare program can begin now. To receive the full incentives available, they must participate by 2014 to receive incentive payments. The last payment year is 2016. Individual providers choosing to participate in the Medicaid program can begin receiving payments when the state initiates the program. To receive incentive payments, providers must begin by 2016. The last year to receive payments is 2021.
Both individual providers and hospitals may be eligible for EHR incentive payments through the Medicaid or Medicare EHR programs, or both. CMS has tried to maintain common eligibility criteria, though, differences do exist. The following are basic eligibility criteria.
Eligibility For Individual Providers – Eligible Professionals (EPs)
Medicaid: A Medicaid eligible professional (EP) is defined as a physician, nurse practitioner, certified nurse-midwife, dentist, or physician assistant who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant. To qualify for an EHR incentive payment, a Medicaid EP must not be hospital-based and 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
Be a physician assistant who practices predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals
Medicare: A Medicare eligible professional (EP) is defined as a doctor of medicine or osteopathy, doctor of dental surgery or dental medicine, doctor of podiatry, doctor of optometry or a chiropractor who is not hospital-based.
EPs Eligible For Both Programs
If you are an EP that is eligible for both the Medicare and the Medicaid incentive programs, you can only participate in one program, not both. You will need to select which program you want to participate in when you register. Here are the general differences:
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Medicare EHR Incentive Program |
Medicaid EHR Incentive Program |
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Can participate as soon as the federal program launches |
Can participate once your state offers the program (Maryland is in the planning stages) |
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Can receive up to $44,000 in incentives, and up to $48,400 if practicing in a Health Provider Shortage Area |
Can receive up to $63,750 in incentives |
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Required to demonstrate meaningful use of certified EHR technology every year to qualify for payment |
In the first year of participation, eligible professionals can qualify for payment for adopting, implementing, or upgrading to certified EHR technology. Those that have a certified EHR, may receive incentives for meaningful use. Required to demonstrate meaningful use in each subsequent year to qualify for payment |
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Must participate by the second year to receive the maximum incentive payment |
Must participate by 2016 to receive the maximum incentive payment |
NOTE: Before 2015, an eligible professional may switch between the Medicare and Medicaid programs (or vice versa) one time after the first incentive payment is initiated.
Medicare Advantage Organization Eligible Professionals: The Medicare Advantage EHR incentive program is structured differently than the Medicare EHR incentive program for Medicare Fee-for-Service providers.
Eligibility for Hospitals - Eligible Hospitals
Medicare: An eligible hospital for Medicare incentive payments must at least be located in one of the 50 states or the District of Columbia. Critical Access Hospitals and Medicare Advantage Hospitals may also be eligible to receive Medicare EHR payments. Complete information on this program is available from CMS.
Medicaid: Acute care hospitals with at least 10% Medicaid patient volume, as well as children's hospitals (no Medicaid volume requirements) may be eligible for Medicaid EHR incentive payments.
NOTE: Some hospitals may receive incentive payments from both Medicare and Medicaid if they meet all eligibility criteria.
For additional information on eligibility, please visit CMS’ page on program eligibility by clicking Here.
