Medicare/Medicaid EHR Incentive Payment Eligibility

The incentives for eligible professionals are based on individual providers. Therefore, if you are part of a practice, each eligible professional may qualify for an incentive payment provided they successfully demonstrate meaningful use. Each EP is only eligible for one incentive payment each year, regardless of how many practices or locations they provide services.

Medicare

A Medicare 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.

NOTE: A Medicare EP is considered hospital-based if 90% or more of the EP's services are performed in a hospital inpatient or emergency room setting.

Medicaid

A Medicaid 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*
  • Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals
NOTE: A medicaid EP is considered hospital-based if 90% or more of the EP's services are performed in a hospital inpatient or emergency room setting. *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 do have the option to switch, one time, between programs.

Who is a Medicare Eligible Provider?

Eligible Professionals (EPs)

  • Doctor of Medicine or Osteopathy
  • Doctor of Dental Surgery or Dental Medicine
  • Doctor of Podiatric Medicine
  • Doctor of Optometry
  • Chiropractor

Eligible Hospitals

  • Acute Care Hospitals*
  • Critical Access Hospitals (CAHs)
  • *Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or Washington D.C. (including Maryland).

Who is a Medicaid Eligible Provider?

Eligible Professionals (EPs)

  • Physicians
  • Nurse Practitioners (NPs)
  • Certified Nurse Midwives (CNMs)
  • Dentists
  • Physician Assistants (PAs) working in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is so led by a PA
  • Optometrists

Eligible Hospitals

  • Acute Care Hospitals (Now including CAHs)
  • Children's Hospitals