Eligibility

Healthcare professionals and hospitals must meet the eligibility criteria defined by law in order to receive incentive payments for implementing Electronic Health Records programs.

Eligible professionals can answer a few quick “yes or no” questions in our Eligibility Wizard to find out which EHR Incentive Programs you may qualify for:

Eligibility Requirements for Professionals

  • Incentive payments for eligible professionals are based on individual practitioners.
  • If you are part of a practice, each eligible professional may qualify for an incentive payment if each eligible professional successfully demonstrates meaningful use of certified EHR technology.
  • Each eligible professional is only eligible for one incentive payment per year, regardless of how many practices or locations at which he or she provide services.
  • Hospital-based eligible professionals are not eligible for incentive payments. An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place Of Service code 21) or emergency room (Place Of Service code 23) setting.

Who is an Eligible Professional under the Medicare EHR Incentive Program?

Eligible professionals under the Medicare EHR Incentive Program include:

  • Doctor of medicine or osteopathy
  • Doctor of dental surgery or dental medicine
  • Doctor of podiatry
  • Doctor of optometry
  • Chiropractor

Who is an Eligible Professional under the Medicaid EHR Incentive Program?

Eligible professionals under the Medicaid EHR Incentive Program include:

  • Physicians (primarily doctors of medicine and doctors of osteopathy)
  • Nurse practitioner
  • Certified nurse-midwife
  • Dentist
  • Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.

To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet one of the following criteria:

  • Have a minimum 30% Medicaid patient volume*
  • Have a minimum 20% Medicaid patient volume, and is a pediatrician*
  • Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals

* Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria.

Eligible for Both Programs?

Eligible professionals eligible for both the Medicare and Medicaid EHR Incentive Programs must choose which incentive program they wish to participate in when they register. Before 2015, an eligible professional may switch programs only once after the first incentive payment is initiated. Most eligible professionals will maximize their incentive payments by participating in the Medicaid EHR Incentive Program.

If you need more information about eligibility, click “Frequently Asked Questions (FAQs)” in the “Related Links Inside CMS” section below.

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Eligibility Requirements for Hospitals

NOTE: Some hospitals may receive incentive payments from both Medicare and Medicaid if they meet all eligibility criteria.

What is an Eligible Hospital under the Medicare EHR Incentive Program?

  • "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

What is an Eligible Hospital under the Medicaid EHR Incentive Program?

  • Acute care hospitals (including CAHs and cancer hospitals) with at least 10% Medicaid patient volume
  • Children's hospitals (no Medicaid patient volume requirements)

Eligible for Both Programs?

Hospitals that are eligible for EHR incentive payments under both Medicare and Medicaid should select “Both Medicare and Medicaid” during the registration process, even if they plan to apply only for a Medicaid EHR incentive payment by adopting, implementing, or upgrading certified EHR technology. Dually-eligible hospitals can then attest through CMS for their Medicare EHR incentive payment at a later date, if they so desire. It is important for a dually-eligible hospital to select “Both Medicare and Medicaid” from the start of registration in order to maintain this option.

Hospitals that register only for the Medicaid program (or only the Medicare program) will not be able to manually change their registration (i.e., change to “Both Medicare and Medicaid” or from one program to the other) after a payment is initiated and this may cause significant delays in receiving a Medicare EHR incentive payment.

If you need more information about eligibility, click “Frequently Asked Questions (FAQs)” in the “Related Links Inside CMS” section below.

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Participating in the EHR Incentive Program and Other Current CMS Incentive Programs
The Medicare and Medicaid EHR Incentive Programs are new and separate programs from other active CMS incentive programs, such as the Physicians Quality Reporting System (PQRS) and the MIPPA E-Prescribing Incentive Program. To see if you can participate in multiple programs, click “Tip Sheet - Medicare EHR Incentive Programs, PQRS, and E-Prescribing Comparison” in the “Downloads” section below.

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