Eligible Professionals

Eligibility Requirements

As of Program Year 2017, the PI Program is no longer accepting first time attesters (AIU) into the program. Therefore, to qualify, you must have completed and been paid for at least one prior attestation. 

EPs* in the Medicaid PI Program include: 

  • Physicians (primarily Doctors of Medicine and Doctors of Osteopathy) 
  • Nurse Practitioner 
  • Certified Nurse-Midwives 
  • Dentists 
  • Physician Assistant who provide services in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) led by a Physician Assistant. 

*Note: In certain states, Optometrists are eligible for the Medicaid PI Program.  For an Optometrist to be eligible, the state Medicaid program must cover adult Optometry services under physician services in the Medicaid State Plan.  Please check with your state Medicaid agency for more information 

To qualify for a Medicaid Incentive Payment, an EP must also meet one of the following criteria: 

  • Have a minimum 30 percent Medicaid patient volume 
  • Be a Pediatrician* and have a minimum 20 percent Medicaid patient volume 
  • Practice predominantly in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) and have a minimum 30 percent patient volume attributable to needy individuals 

Security Risk Assessment

You must conduct a Security Risk Assessment at some point during each year in order to qualify for the PI Incentive Payment. You will be responsible for submitting the entire SRA for the 2018 Program Year. It is important that the SRA is completed correctly, because after you have attested to the PI Program for that year, it is usually too late to go back and redo it. You can 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 Professional 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 PI 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 PI 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 PI Program, EPs must successfully attest to AIU or Meaningful use. Below are the requirements for each stage.