Eligible Professionals

Eligibility Requirements

As of Program Year 2017, the EHR Incentive Program is no longer accepting first time attestors (AIU) into the program. Therefore, to qualify, you must have completed and been paid for at least one prior attestation, as well as match all of the requirements below.

To participate in the Medicaid EHR Incentive Program, providers must be one of the following qualified types of medical professionals:

  • Physicians
  • Nurse Practitioners
  • Dentists
  • Certified Nurse Midwives (CNMs)
  • Physicians Assistants (PAs) when practicing predominantly at a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is led by a PA

Additionally, an eligible professional must meet one of the following criteria:

  • Have a minimum 30% Medicaid patient volume
  • Have a minimum 20% Medicaid patient volume, and be a pediatrician
  • Practice predominantly in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) and have a minimum 30% patient volume attributable to needy individuals.

Hospital-based professionals are not eligible for incentive payments. A professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place of Service code 21) or emergency room (Place of Service code 23) setting.

Security Risk Assessment

You must conduct a Security Risk Assessment at some point during each year in order to qualify for the EHR Incentive Payment. You can use this SRA Checklist to help you make sure that all of the steps have been completed or have a plan to be completed. It is important that the SRA is completed correctly, because after you have attested to the EHR Incentive program for that year, it is usually too late to go back and redo it. You can also find an SRA tipsheet below, in the section about the Post-Payment Audit.

Post-Payment Audit

Post-payment audits are conducted on a random subset of the providers who attest each year. They are conducted by Myers & Stauffer, who are the ones who will contact you if you are chosen for an audit. They have provided some tip sheets for providers to make the audit process easier. You can read Tips for Completing a Security Risk Analysis, which can be helpful even if you are not contacted for an audit, and Eligible Provider Post Payment Review Tips.

Certified Electronic Health Record (EHR)

What is an EHR?

An electronic health record (EHR)—sometimes called an electronic medical record (EMR)—allows health care providers to record patient information electronically instead of using paper records. However, EHRs are often capable of doing much more than just recording information. The EHR Incentive Program asks providers to use the capabilities of their EHRs to achieve benchmarks that can lead to improved patient care.

 

What is a certified EHR?

CMS and the Office of the National Coordinator for Health Information Technology (ONC) have established standards and other criteria for structured data that EHRs must use in order to qualify for this incentive program.

To get an incentive payment, EPs must use an EHR that is certified specifically for the EHR Incentive Program.

To find a certified EHR, go to ONC's Certified Health IT Product List

 

Register

  1. Register with CMS online at https://ehrincentives.cms.gov/.
  2. Once you have registered with CMS and MAPIR has received and matched your provider information, you will receive an email to begin the MAPIR application process.

Adopt, Implement, Upgrade

During the first year of participation, EPs can meet the CMS requirements by doing one of the following:

Adopt an EHR: acquire and install certified EHR technology.

Implement an EHR: Begin using certified EHR technology.

Upgrade to an EHR: Expand existing technology to meet certification requirements.

Meaningful Use

After the first year of participation, EPs must demonstrate that they have meaningfully used their certified EHR by completing the following:

Attest

To be eligible for an incentive payment in the Medicaid EHR Incentive Program, EPs must successfully attest to AIU or Meaningful use. Below are the requirements for each stage.

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