Fall QCLC - Differences Between the Medicare and Medicaid EHR Incentive Programs

With the exception of dually-eligible hospitals, providers can only participate in one of the EHR Incentive Programs – Medicare or Medicaid – each year.  We’ve outlined key differences between the Medicare and Medicaid EHR Incentive Programs to help you determine which EHR Incentive Program is right for you.

Who is eligible?

For the Medicare EHR Incentive Program, eligible participants include:

§  Doctors of medicine or osteopathy

§  Doctors of dental surgery or dental medicine

§  Doctors of podiatry

§  Doctors of optometry

§  Chiropractors

§  "Subsection (d) hospitals" in the 50 states or DC that are paid under the Inpatient Prospective Payment System (IPPS)

§  Critical Access Hospitals (CAHs)

§  Medicare Advantage (MA-Affiliated) Hospitals

For the Medicaid EHR Incentive Program, eligible participants include:

§  Physicians (primarily doctors of medicine and doctors of osteopathy)

§  Nurse practitioners

§  Certified nurse-midwives

§  Dentists

§  Physician assistants who furnish services in a Federally-Qualified Health Center or Rural Health Clinic that is led by a physician assistant

§  Acute care hospitals (including CAHs and cancer hospitals) with at least 10% Medicaid patient volume

§  Children’s hospitals (no Medicaid patient volume requirements)

Dually-Eligible Hospitals

If you represent a hospital that meets all of the following qualifications, you are dually-eligible for the Medicare and Medicaid EHR Incentive Programs:

§   You are a subsection (d) hospital in the 50 states or DC, or you are a CAH; and

§   You have a CMS Certification Number ending in 0001-0879 or 1300-1399; and

§   You have 10% of your patient volume derived from Medicaid encounters.

We encourage potential participants to review CMS’s comparison chart to learn more about the differences between the two EHR Incentive Programs, and use the Eligibility Wizard to determine for which program they may be eligible.

Want more information about the EHR Incentive Programs? Visit the CMS EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs; also sign up for the EHR Incentive Programs email update listserv.