Medicaid “Incentive Payments for Eligible Professional

Florida will be ready to begin making the Florida Medicaid EHR incentive payments in September 2011, but you can start preparing now.

The incentive program does not provide additional incentive payments beyond the limits established by legislation, regardless of your EHR system’s cost. The purpose of the incentive payments is to encourage the adoption and meaningful use of certified EHR technology, not to act as a direct reimbursement. The CMS final rule does not dictate how Medicaid providers must use their EHR incentive payment.

Eligible professionals (EPs) can receive $63,750 over six years. Pediatricians who qualify with a 20-29% Medicaid patient volume receive two-thirds of the maximum incentive payment, totaling $42,500. Pediatricians who qualify with a 30% Medicaid patient volume can receive the full incentive payment.

EPs may receive an incentive payment from either Medicaid or Medicare, but not both. A Medicaid eligible professional may receive an incentive payment from only one state in a payment year.

An EP can participate in the Medicaid EHR Incentive Program and CMS eRx Incentive Program simultaneously.

Calendar Year    Payment

Year 1         $21,250
Year 2         $8,500
Year 3         $8,500
Year 4         $8,500
Year 5         $8,500
Year 6         $8,500
Total          $63,750

Eligible Professionals for Medicaid

Eligible professionals (EPs) are non-hospital-based physicians, dentists, nurse practitioners, and certified nurse midwives. Additionally, physician assistants practicing predominantly in a Federally Qualified Health Center (FQHC)

EPs can receive $63,750 over six years for adopting, implementing or upgrading and demonstrating meaningful use of certified EHR technology. Medicaid providers may opt out of the incentive program without their Medicaid reimbursements being affected. EPs can switch between the Medicare and Medicaid incentive programs one time. The last year for making an incentive program switch is 2014.

Eligible professionals must meet the following patient volume requirements.

Non-Hospital-Based Eligible Professionals            Patient Volume Over 90-Day Period

Physician (MD, DO)                                                 30% Medicaid
Dentist                                                                      30% Medicaid
Certified Nurse Midwife                                            30% Medicaid
Nurse Practitioner                                                      30% Medicaid
Physician Assistant (PA) in a RHC or FQHC led by PA*    30% Medicaid
Pediatrician**                                                             20% Medicaid

* Eligible professionals that practice in a RHC or FQHC at least 50% of the time can count “needy individuals”1 to meet their patient volume threshold.

**Pediatricians, like other physicians, can be eligible for the full incentive payment ($63,750) if they meet the minimum 30% Medicaid patient volume requirements. However, Pediatricians only are also eligible if their Medicaid patient volume is between 20-29%. Pediatricians who qualify with a 20-29% Medicaid patient volume receive two-thirds of the maximum incentive payment, totaling $42,500.

*** Non-Hospital-Based is defined as not having 90% or more necounters in a hospital or emergency room setting.