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Medicaid & Medicare Reimbursement Requirements

EMR Incentive Center

FAQs for Eligible Providers

Incentive Reimbursement Requirements for Medicaid and Medicare

Find out!

What you need to know

Who is eligible for Medicare incentive reimbursements?

Office-based EPs who demonstrate meaningful use of an electronic medical record (EMR) system, including Doctor(s) of Medicine or Osteopathy, Doctor(s) of Dental Surgery or Dental Medicine, Doctor(s) of Podiatric Medicine, Doctor(s) of Optometry and Chiropractors are eligible, provided they began attesting to meaningful use in the year 2014 or earlier. Hospital-based EPs are not eligible for the program.

Who is eligible for Medicaid incentive reimbursements?

Those allowed to submit for incentives are:

  • Physicians
  • Nurse Practitioners (NPs)
  • Certified Nurse Midwives (CNMs)
  • Dentists
  • Physician Assistants (PAs) who work in a Federally Qualified Health Center (FQHC) or a Rural Health Clinic (RHC) that is led by a Physician Assistant.

In order to be eligible for incentives, providers must have 30% of patient volume in Medicaid OR 20% of patient volume in Medicaid if the provider is a Pediatrician OR work in an FQHC or RHC where 30% of the patient volume is made up of needy individuals.

Who is not eligible for incentive reimbursements?

Providers furnishing more than 90% of their services in an inpatient setting or hospital ER.

Provider Requirements

Of course, only Medicare and Medicaid providers are eligible for a CMS EHR Incentive Program. Providers must be meaningfully using an EMR certified by an ONC Approved Testing and Certification Body (ATCB) for 90 days consecutively in the first reimbursement payment year. For future reimbursement years, providers must meaningfully use the system for the full year. Providers will need to select and register for a single program to participate in, either Medicare or Medicaid. Providers also need to “attest” that they are meaningfully using a certified EMR according to the selected program requirements through self-attestation, claims data and EMR-generated reports.

What’s next? Register for a program

Providers who have not already registered for the Medicare program are no longer eligible to earn reimbursements, but can still register to prevent further payment penalty adjustments. Registration for the Medicare program is done through the CMS EHR Incentive Program Website. As the Medicaid program is established by each state, providers who have not yet registered will need to check with their state Medicaid organization to verify how to register and what, if anything, is different from the federal Medicaid program. Click here to access the CMS list of Medicaid programs and their current status.