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Medicare Advantage

Medicare Advantage organizations may also qualify to receive Promoting Interoperability payments.

Under the Medicare Advantage Promoting Interoperability Program, payments are made only to Medicare Advantage organizations that are licensed as HMOs, or in the same manner as HMOs, by a state. These Medicare Advantage organizations may receive incentive payments by way of Medicare Advantage eligible professionals (EPs) and Medicare Advantage hospitals (MA-affiliated hospitals).

Who are Medicare Advantage EPs?

Medicare Advantage EPs are physicians that are either:

  • Employed by the Medicare Advantage organization

OR

  • Employed by, or partner of, an entity through a contract with the Medicare Advantage organization, that furnishes at least 80 percent of that entity's Medicare patient care services to enrollees of the Medicare Advantage organization.

Also, Medicare Advantage EPs must furnish at least 80 percent of their Medicare-related professional services to enrollees of the MA organization and must furnish, on average, at least 20 hours per week of patient care services.

Medicare Advantage EPs cannot directly receive an incentive payment through the PI Programs. PI payments for Medicare Advantage EPs will be paid to the Medicare Advantage organization.

 

What is a Medicare Advantage affiliated hospital?

Medicare Advantage affiliated hospitals are hospitals that:

  • Are under a common corporate governance with the Medicare Advantage organization

AND

  • Serve individuals enrolled under Medicare Advantage plans offered by the Medicare Advantage organization, where less than one-third are Medicare individuals covered under Medicare Part A.

 

For additional information regarding the Medicare Advantage EHR incentive payment, please review section 4101(c) of subtitle D of the HITECH ACT.

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