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Fee-for-Service Medicare Incentive Payment
Incentive Payment - Calculation
Under FFS Medicare, the payment incentive amount, subject to an annual limit, is equal to 75 percent of an EP’s Medicare physician fee schedule allowed charges submitted not later than 2 months after the end of the calendar year. This means that, for 2011, the EHR incentive payment for an EP would be, subject to an annual limit, equal to 75% of the EP’s Medicare physician fee schedule allowed charges for CY 2011, based on claims for services performed by the EP from January 1, 2011 through December 31, 2011, and submitted to the EP’s Medicare contractor (MAC/carrier) no later than February 29, 2012.
Table 1: Maximum Incentive Payments Based on the First CY in Which an EP Participates in the Program
| Calendar Year | Maximum Incentive Payments | Maximum Incentive Payments | Maximum Incentive Payments | Maximum Incentive Payments |
|---|---|---|---|---|
| 2011 | 2012 | 2013 | 2014 | |
| 2011 | $18,000 | |||
| 2012 | $12,000 | $18,000 | ||
| 2013 | $8,000 | $12,000 | $15,000 | |
| 2014 | $4,000 | $8,000 | $12,000 | $12,000 |
| 2015 | $2,000 | $4,000 | $8,000 | $8,000 |
| 2016 | $2,000 | $4,000 | $4,000 | |
| Total | $44,000 | $44,000 | $39,000 | $24,000 |
Table 2: Maximum Incentive Payments for an EP Who Qualifies for an HPSA Bonus Payment Based on the First CY in Which the EP Participates in the Program
| Calendar Year | Maximum Incentive Payments | Maximum Incentive Payments | Maximum Incentive Payments | Maximum Incentive Payments |
|---|---|---|---|---|
| 2011 | 2012 | 2013 | 2014 | |
| 2011 | $19,800 | |||
| 2012 | $13,200 | $19,800 | ||
| 2013 | $8,800 | $13,200 | $16,500 | |
| 2014 | $4,400 | $8,800 | $13,200 | $13,200 |
| 2015 | $2,200 | $4,400 | $8,800 | $8,800 |
| 2016 | $2,200 | $4,400 | $4,400 | |
| Total | $48,400 ($4,400 increase) |
$48,400 ($4,400 increase) |
$42,900 ($3,900 increase) |
$26,400 ($2,400 increase) |
Table 3: Maximum Incentive Payments Based on the First CY in Which the MAO EP Participates in the Program
| Calendar Year | Maximum Incentive Payments | Maximum Incentive Payments | Maximum Incentive Payments | Maximum Incentive Payments |
|---|---|---|---|---|
| 2011 | 2012 | 2013 | 2014 | |
| 2011 | $18,000 | |||
| 2012 | $12,000 | $18,000 | ||
| 2013 | $8,000 | $12,000 | $15,000 | |
| 2014 | $4,000 | $8,000 | $12,000 | $12,000 |
| 2015 | $2,000 | $4,000 | $8,000 | $8,000 |
| 2016 | $2,000 | $4,000 | $4,000 | |
| Total | $44,000 | $44,000 | $39,000 | $24,000 |
Medicaid EHR Incentive Payment
Incentive Payment - Volume Requirements
To be eligible to participate in the Medicaid EHR Incentive Program, an EP must either: (1) Meet certain Medicaid patient volume thresholds or (2) practice predominantly in an FQHC or RHC where 30 percent of the patient volume is derived from needy individuals.1 One exception to this rule is that a pediatrician may have at least 20 percent Medicaid patient volume and still qualify but at a reduced incentive.
Table 1: Patient Volume Thresholds per Provider Type
| Entity | Minimum Medicaid Patient Volume Threshold | Or the Medicaid EP practices predominately in an FQHC or RHC with a 30 percent “needy individual” patient volume threshold |
|---|---|---|
| Physician | 30% | |
| Pediatrician | 20% | |
| Dentist | 30% | |
| Certified nurse-midwife | 30% | |
| Nurse practitioner | 30% | |
| Physician assistant when practicing in an FQHC/RHC led by a physician assistant | 30% |
Incentive Payment - Patient Volume Calculation
The Medicaid patient volume methodology will be designated by the State Medicaid Agency and approved by CMS. Note: The final rule describes acceptable methods for estimating patient volume. In determining patient volume thresholds, EPs should include individuals enrolled in Medicaid managed care organizations, prepaid inpatient health plans, prepaid ambulatory health plans, and Medicaid medical home programs or Primary Care Case Management.
Table 2: Medicaid EHR Incentive Payments by Calendar Year
| Year | Medicaid EPs Who Adopted In | Medicaid EPs Who Adopted In | Medicaid EPs Who Adopted In | Medicaid EPs Who Adopted In | Medicaid EPs Who Adopted In | Medicaid EPs Who Adopted In |
|---|---|---|---|---|---|---|
| 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | |
| 2011 | $21,250 | |||||
| 2012 | $8,500 | $21,500 | ||||
| 2013 | $8,500 | $8,500 | $21,500 | |||
| 2014 | $8,500 | $8,500 | $8,500 | $21,500 | ||
| 2015 | $8,500 | $8,500 | $8,500 | $8,500 | $21,500 | |
| 2016 | $8,500 | $8,500 | $8,500 | $8,500 | $8,500 | $21,500 |
| 2017 | $8,500 | $8,500 | $8,500 | $8,500 | $8,500 | |
| 2018 | $8,500 | $8,500 | $8,500 | $8,500 | ||
| 2019 | $8,500 | $8,500 | $8,500 | |||
| 2020 | $8,500 | $8,500 | ||||
| 2021 | $8,500 | |||||
| Total | $63,750 | $63,750 | $63,750 | $63,750 | $63,750 | $63,750 |
Source: CMS