Medicare Advantage

Medicare Advantage
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).

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.

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 Promoting Interoperability Programs. Promoting Interoperability Program payments for Medicare Advantage EPs will be paid to the Medicare Advantage organization.

Medicare Advantage Affiliated Hospitals

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.

Medicare Advantage Affiliated eligible hospitals in Puerto Rico:

  • Section 602(a) of the Consolidated Appropriations Act, 2016 amended section 1886(n)(6)(B) of the Act to include subsection (d) Puerto Rico hospitals in the definition of “eligible hospital”.
  • FY 2016 is the first payment year for which an EHR incentive payment could be made to an eligible hospital that is a meaningful EHR user. They payment year will end with FY 2021.
  • Puerto Rico hospitals will follow the same reporting period that is used for the Medicare Promoting Interoperability Program.

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

Page Last Modified:
09/06/2023 04:57 PM