EHR Federal Incentive Programs

The Health Information Technology for Economic and Clinical Health (HITECH) Act, was enacted as part of the American Recovery and Reinvestment Act of 2009 and established a Medicare and Medicaid EHR Incentive Program. The incentive payments will start in 2011 and are available to eligible healthcare providers and eligible hospitals when they implement a certified EHR technology and successfully demonstrate meaningful use of such technology.

Medicare Incentive Program

An eligible professional under the Medicare incentive program can receive incentive payments for up to 5 years. The maximum amount of total payments is $44,000.

An eligible professional under the Medicare incentive program includes doctors of medicine or osteopathy, doctors of dental surgery or dental medicine, doctors of Podiatric medicine, doctors of optometry and chiropractors. Eligible professionals may not be hospital-based. Hospital-based is defined as any provider who furnishes 90% or more of their time in a hospital setting, which includes both inpatient and emergency room visits.

A qualifying eligible professional (an eligible professional that demonstrates meaningful use of certified EHR technology) will receive an incentive payment equal to 75 percent of Medicare fee-for-service allowable charges for covered services. These incentive payments are subject to maximum limitations. The Medicare incentive payment table below illustrates the maximum incentive payments an eligible professional can receive. For example, the maximum incentive payment for 2011 and 2012 is $18,000. The longer an eligible professional waits to implement an EHR system, the less incentive payments they receive.

Medicaid Incentive Program

An eligible healthcare provider under the Medicaid incentive program can receive incentive payments for up to 6 years. The maximum amount of total payments is $63,750.

An eligible professional under the Medicaid EHR incentive program include physicians (primarily doctors of medicine and doctors of osteopathy), nurse practitioners, certified nurse-midwives, dentists and physician assistants who furnish services in a Federally Qualified Health Center or Rural Health Clinic.

To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible individual must meet one of the following criteria:

• Have a minimum 30% Medicaid patient volume

(Children’s Health Insurance Program patients do not count toward the Medicaid patient volume criteria)

• Have a minimum 20% Medicaid patient volume, and is a pediatrician

(Children’s Health Insurance Program patients do not count toward the Medicaid patient volume criteria)

• Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals

A qualifying eligible professional (an eligible professional that demonstrates meaningful use of certified EHR technology) will receive an incentive payment equal to 85 percent of the net average allowable costs for certified EHR technology, including support and training. These incentive payments are subject to maximum limitations. The Medicaid incentive payment table below illustrates the maximum incentive payment for the first year is $21,250 with payments limited to $8,500 for the subsequent 5 years of program participation.