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Medicare and Medicaid EHR Incentive Program Basics

Beginning in 2011, the Electronic Health Records (EHR) Incentive Programs were developed to encourage eligible professionals and eligible hospitals to adopt, implement, upgrade (AIU), and demonstrate meaningful use of certified EHR technology.

As of October 2015, more than 479,000 health care providers received payment for participating in the Medicare and Medicaid EHR Incentive Programs.

CMS recently published a final rule that specifies criteria that eligible professionals, eligible hospitals and critical access hospitals (CAHs) must meet in order to participate in the Medicare and Medicaid EHR Incentive Programs in 2015 through 2017 (Modified Stage 2) and in Stage 3 in 2017 and beyond.

New Participation Requirements Beginning in 2015
Through the EHR Incentive Programs’ requirements for 2015 through 2017 (Modified Stage 2) and Stage 3, CMS will focus on advanced use of certified EHR technology to support health information exchange and interoperability, advanced quality measurement, and maximizing clinical effectiveness and efficiencies.

Changes to Meaningful Use Requirements

  • All providers are required to attest to a single set of objectives and measures, beginning in 2015.
  • For all eligible professionals in 2015 through 2017 (Modified Stage 2), there are 10 objectives. For all eligible hospitals and CAHs, there are 9 objectives.
  • Beginning on a voluntary basis in 2017 and required beginning in 2018, all providers will attest to Stage 3 objectives and measures. More information about reporting in 2017 and beyond will be available in 2016.
  • Additional information related to EHR Incentive Programs’ requirements for 2015 through 2017 (Modified Stage 2) and Stage 3 can be found in the final rule.

EHR Reporting Periods

  • In 2015 only, the EHR reporting period for all providers will be any continuous 90-day period within the calendar year.
  • Starting in 2016, the EHR reporting period for eligible professionals, eligible hospitals, and CAHs will begin and end based on the calendar year.

Additional Information for Eligible Professionals Participating in the Medicare EHR Incentive Program:

  • Beginning in 2015, eligible professionals who do not successfully demonstrate meaningful use will be subject to a payment adjustment. The payment reduction starts at 1% and increases each year that an eligible professional does not demonstrate meaningful use, to a maximum of 5%.
  • Additional information on payment adjustments can be found on the Payment Adjustments & Hardship Information page.

Additional Information for Eligible Professionals Participating in the Medicaid EHR Incentive Program:

  • The program is administered voluntarily by states and territories, and will pay incentives through 2021. Eligible professionals are eligible for incentive payments for 6 years, and participation years do not have to be consecutive.
  • The last year that an eligible professional can begin participation is 2016. Incentive payments for eligible professionals are higher under the Medicaid EHR Incentive Payments— up to $63,750 over 6 years.
  • Eligible professionals can receive an incentive payment for adopting, implementing, or upgrading (AIU) certified EHR technology in their first year of participation.
    • In subsequent years, eligible professionals can receive incentive payments for successfully demonstrating meaningful use.
  • If you qualify for both the Medicare and Medicaid EHR Incentive Programs, you must choose which program you want to participate in. If you are only eligible for the Medicaid EHR Incentive Program, you will not be subject to payment adjustments.
  • Medicaid eligible professionals who also treat Medicare patients will have a payment adjustment to Medicare reimbursements starting in 2015 if they do not successfully demonstrate meaningful use.

For information about the EHR Incentive Programs in previous years, visit the Requirements for Previous Years page.