Meaningful Use Mondays – Participation Under Medicare vs. Medicaid

Physicians who are eligible for both programs will likely find participation under Medicaid to be a preferable option because the incentives are higher, the first year rewards adoption/purchase, (without requiring demonstration of meaningful use depending on the state); and the program offers more flexibility in terms of time frames. To participate under Medicaid, a provider must have a practice that is 30% Medicaid (20% for pediatricians), based on number of patient encounters (as opposed to revenue). Some providers are only eligible under Medicaid—nurse practitioners; certified nurse-midwives; dentists; and physician assistants who practice in a Federally Qualified Health Center or rural health clinic that is led by a physician assistant.

Not all states have their EHR incentive programs ready to go yet. 14 states will launch in either January or February; others are expected later in the year.

The major differences between the Medicare and Medicaid incentive programs that providers should take into consideration when making their choice at registration include the following:

MEDICARE MEDICAID
Maximum Incentive $44,000 over 5 years

(+10% for EPS in HPSAs)

$63,750 over 6 years ($42,500 for pediatricians w. 20-30% Medicaid)
First payment year Requires meaningful use $21,250 for adoption, imple-

mentation, upgrading to EHR

($14,167 for pediatricians w. 20-30% Medicaid)

Latest start time to earn maximum 2012

Must start by 2014 to qualify for any incentives

2016
Last payment year 2016 2021
Eligibility for concurrent ePrescribing bonus (MIPPA) No Yes

Next Monday’s post will highlight some other differences between the two programs that are interesting, but less influential.

Lynn Scheps is Vice President, Government Affairs at EMR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

About the author

Lynn Scheps

Lynn Scheps

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

2 Comments

  • Interesting post about the first payments from Medicaid going out in the MU incentive program; this includes Hospitals and Professionals
    “First Payment Details

    In Kentucky, the University of Kentucky Healthcare received $2.8 million and Central Baptist Hospital in Lexington received $1.3 million from the Medicaid incentive program. The two hospitals were the first in the U.S. to receive checks under the stimulus package (Merrill, Healthcare IT News, 1/6).

    Twenty-five additional health care providers in Kentucky have started the application process, according to the state (Business First of Louisville, 1/6).

    In Oklahoma, two physicians at the Gastorf Family Clinic in Durant each received $21,250 under the Medicaid EHR incentive program.”

    Read more: http://www.ihealthbeat.org/articles/2011/1/7/kentucky-oklahoma-first-states-to-dish-out-incentive-payments.aspx#ixzz1Ajrk33dp

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