Healthcare Training: Learn Who Qualifies for EHR Bonus Incentive

For a Medicare provider, who's eligible for the stimulus money? Well, a doctor, an MD or DO, a doctor of dental surgery or medicine, a doctor of podiatric medicine, a doctor of optometry and then a chiropractor as per the Medicare guidelines.

For Medicaid now, it's physicians, primarily MDs and Dos but they also include nurse practitioners, certified nurse midwives, dentists and then physician assistants who furnish services in a federally qualified health center or rural health clinic that's led by a physician assistant.

Now, to qualify for an incentive payment under Medicaid as per associated healthcare guidelines, the Medicaid EHR incentive program, an eligible professional has to meet one of these criteria: they have to have a minimum of 30% Medicaid patient volume or have a minimum of 20% Medicaid patient volume and be a pediatrician or practice in a predominantly and a federally qualified health center or rural health center and have a minimum of 30% patient volume that's attributable to needy individuals.

And insurance program patients, they don't count toward the Medicaid patient volume criteria.

If the provider does Medicare Advantage, they have to furnish on average at least 20 hours per week of patient care services or be employed by a federally qualifying Medicare Advantage organization or they have to be employed by or partner of an entity through a contract with a qualifying Medicare Advantage organization, it furnished at least 80% of the entity's Medicare patient's care services to the enrollees of that Medicare Advantage qualifying organization.

It's a little confusing. But if you're Medicare, you may be eligible. If you're Medicaid, you may be eligible. And then if you're a Medicare Advantage provider, you may be eligible.

Now, if you're an eligible professional that let's say you're eligible for both Medicare and Medicaid incentives, you have to choose. You can only participate in one program as per healthcare rules. You can't do both.

Now, if you choose one and you decide you want to go with the other one, you can change one time. So before 2015, you can switch programs one time after the first incentive payment is initiated. So you'd have to do it until after you receive your first payment from the program you're enrolled in before you can switch programs.

Now, it's said that most eligible professionals will earn the most through the Medicaid EHR incentive program versus the Medicare.

Incentive payments are made on per eligible professional basis, not by practice or group. So that means based on individual practitioners, each one in a practice could qualify. Each eligible professional has to demonstrate the full requirements of meaningful use in order to qualify but more than one eligible professional in a practice can earn the stimulus bonus.

Healthcare Training Tip: Now, each eligible professional is only eligible for one incentive payment regardless of how many practices or locations that they may provide services. So only one time per eligible professional has to choose between Medicare and Medicaid. You can change after the first bonus payment is made.

Now, if you're a hospital-based eligible provider, you're really not eligible because you're considered hospital-based if 90% or more health services are performed in a hospital in-patient or emergency room setting, our expert mentioned in a healthcare webinar.

So if you're using place of service code 23 or 21, you're considered hospital-based if you do 90% or more of your services using those service codes. So if you're doing that, you're not eligible to participate.

Now, you have to demonstrate meaningful use of a certified – now that's an important word – certified EHR technology in a meaningful manner using e-prescribing, the ability to exchange information. These are all parts of the meaningful use. And you have to submit performance and quality measures to the secretary of HHS during the reporting period for each payment year.

Now, this reporting period is the attestation which would be the final step to earn the stimulus bonus. So once you register and attest for the program, if you're doing e-prescribing, you're no longer going to be eligible for the e-prescribing bonus because that's part of the meaningful use criteria in order to earn the stimulus bonus. You can earn one or the other but not both.

Now you can still earn CMS PQRS bonus but not the e-prescribing once you enroll for the electronic prescribing bonus program.

Now, who's not eligible? If you're hospital based and 90% of your services are provided in the hospital or outpatient, you're not eligible. Practices that don't bill either Medicare or Medicaid are not eligible.

Physical therapists and then other hospital-based physicians such pathologists, anesthesiologists, emergency physicians and then acupuncturist or other holistic providers, you're not eligible.

Visit AudioEducator and get expert healthcare training on recent PQRS measures and qualify for every possible incentive.


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