Meaningful Use Basics and Eligibility

The 2009 ARRA Act led to the creation of the Medicaid EHR Incentive Program. PCC practices that use PCC EHR can apply for the Medicaid EHR Incentive Program.

The best summary of what the program does is found on CMS.gov:

“The Medicaid EHR Incentive Program provides incentive payments to eligible professionals, eligible hospitals, and critical access hospitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. To receive the incentive payments, providers must show that they are meeting a number of objectives and demonstrating meaningful use of their EHRs. There are no penalties for not participating in the Medicaid EHR Incentive Program.”

You can learn more about the program at CMS.gov’s EHR Incentive Programs page.

How Do I Know If I Am Eligible to Apply?

Your pediatric practice may be able to apply to the EHR Medicaid Incentive program, a process sometimes called “apply for ARRA funds”, if:

  • You use PCC software, or another certified EHR, in at least 50% of your patient encounters.
  • At least 20% of the services offered by one or more pediatricians at your practice are furnished to Medicaid patients in an outpatient setting. Nurse Practitioners can also be part of your submission if 30% of their services are Medicaid. (Alternatively, you can apply if your practice is predominantly in a Federally Qualified Health Center or Rural Health Clinic where 30 percent of the patient volume is derived from needy individuals.)

Medicaid patient volume is calculated by dividing the provider’s encounters with Medicaid-enrolled patients over the provider’s total number of service encounters. PCC can help you find those numbers. Note that Children’s Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria.

Your whole office can make workflow and policy changes to help meet Meaningful Use and report on CQMs, and your entire patient population can benefit from those changes. The reporting and evaluation for the EHR Medicaid Incentive program, however, and the resulting incentive, is always done based on eligible professionals who see a certain percentage of Medicaid patients.

When Can I Apply?

You can begin applying to the Medicaid EHR Incentive Program now. The last year you may begin is 2016.

Once you are part of the program, you may continue your participation for up to six years, through the program’s conclusion in 2021. You may stop participating at any time without penalty.

What Must I Do to Qualify for Funds from the Medicaid EHR Incentive Program?

To receive funds from the program, an eligible pediatrician must adopt, implement, upgrade, or meaningfully use their certified EHR technology.

Just by adopting PCC EHR or upgrading to the 2014-certified version of PCC EHR in your practice, you meet the qualifications for your first year of participation in the Medicaid EHR Incentive program.

For each subsequent year, your practice must meet additional goals and submit reports to demonstrate that your practice meets Meaningful Use guidelines and can report on 9 Clinical Quality Measures. For more information, read Meet Meaningful Use with PCC (COMING SOON) and Clinical Quality Measures with PCC (COMING SOON).

How Much Money Can My Practice Receive From the Medicaid EHR Incentive Program?

In the first year of a pediatrician’s or nurse practitioner’s participation in the program, they can receive $21,250 if they have a 30-percent medicaid visit volume. Pediatricians that achieve 20% can receive 2/3rds of that amount, or $14,167.

In the first year of participation, if your practice has five pediatricians, and three of them see 30% or more in medicaid patient volume and two of them see between 20 and 29.99% in medicaid patient volume, your practice could receive $92,083 through the program.

In subsequent years, each eligible professional can receive $8500 for five years, depending on program participation.

How Do I Get Started Applying?

Visit CMS.gov’s EHR Incentive Programs website to learn more.

The pages on that site can help provide an overview of the process, providing training videos and checklists for your application.

The Medicaid EHR Incentive Program is administered by your state’s Medicaid agency. There may be regional differences, state-by-state, and you should work closely with your state’s agency during your application process.

Finally, PCC Learn’s Meaningful Use, CQMs, ARRA’s EHR Medicaid Incentives, and PCMH section can help you figure out how to use PCC software to meet requirements of the EHR Medicaid Incentive program.

  • Last modified: November 10, 2017