Medicare EHR Incentive Payments

Under FFS Medicare, the payment incentive amount, subject to an annual limit, is equal to 75 percent of an EP’s Medicare physician fee schedule allowed charges submitted not later than 2 months after the end of the calendar year. This means that, for 2011, the EHR incentive payment for an EP would be, subject to an annual limit, equal to 75% of the EP’s Medicare physician fee schedule allowed charges for CY 2011, based on claims for services performed by the EP from January 1, 2011 through December 31, 2011, and submitted to the EP’s Medicare contractor (MAC/carrier) no later than February 29, 2012.

Calendar
Year
Maximum
Incentive Payments
Maximum
Incentive Payments
Maximum
Incentive Payments
Maximum
Incentive Payments
  2011 2012 2013 2014
2011 $18,000      
2012 $12,000 $18,000    
2013 $8,000 $12,000 $15,000  
2014 $4,000 $8,000 $12,000 $12,000
2015 $2,000 $4,000 $8,000 $8,000
2016   $2,000 $4,000 $4,000
Total $44,000 $44,000 $39,000 $24,000

Medicaid EHR Incentive Payment

Incentive Payment - Volume Requirements

To be eligible to participate in the Medicaid EHR Incentive Program, an EP must either: (1) Meet certain Medicaid patient volume thresholds or (2) practice predominantly in an FQHC or RHC where 30 percent of the patient volume is derived from needy individuals. One exception to this rule is that a pediatrician may have at least 20 percent Medicaid patient volume and still qualify but at a reduced incentive.

Calendar
Year
Maximum
Incentive Payments
Maximum
Incentive Payments
Maximum
Incentive Payments
Maximum
Incentive Payments
  2011 2012 2013 2014
2011 $21,250      
2012 $8,500 $21,250    
2013 $8,500 $8,500 $21,250  
2014 $8,500 $8,000 $8,500 $21,250
2015 $8,500 $8,500 $8,500 $8,500
2016 $8,500 $8,500 $8,500 $8,500
2017   $8,500 $8,500 $8,500
2018     $8,500 $8,500
2019       $8,500
Total $63,750 $63,750 $63,750 $63,750
Incentive Payment - Patient Volume Calculation

The Medicaid patient volume methodology will be designated by the State Medicaid Agency and approved by CMS. Note: The final rule describes acceptable methods for estimating patient volume. In determining patient volume thresholds, EPs should include individuals enrolled in Medicaid managed care organizations, prepaid inpatient health plans, prepaid ambulatory health plans, and Medicaid medical home programs or Primary Care Case Management.