Determine which EHR Incentive Program is right for your practice

May 1, 2011

The EHR Incentive Program offers bonus payments for eligible professionals who make meaningful use of a certified system. Although the government's initiative is labeled under a single moniker, there are really two distinct programs for eligible professionals: Medicare and Medicaid. When you register for the EHR Incentive Program, you must choose one or the other.

Key Points

The government began to accept attestation from healthcare providers via its online Registration & Attestation System on April 18 - the final step to open for business its newly launched incentive program for electronic health records (EHRs).

Although the government's initiative is labeled under a single moniker, there are really two distinct programs for eligible professionals: Medicare and Medicaid. When you register for the EHR Incentive Program, you must choose one or the other. (Eligible hospitals, in contrast, can participate in both programs.)

Incentive payment

Let's start with the most important issue - the bonus payment. The payment for Medicaid is substantially higher than Medicare; Medicaid pays $63,750 over a period of six years, while Medicare offers $44,000 over five.

In the case of Medicaid, the bonus is flat. If you qualify, that's it: You get the bonus. In the initial payment year, you'll receive $22,500, with the remainder paid in $8,500 annual installments over the subsequent five years. For Medicare, the bonus is a cap - payment is tied to 75 percent of your total allowed Medicare fee-for-service professional charges up to a maximum amount.

In other words, you must bill $24,000 to Medicare in order to garner the initial year's $18,000 bonus. If you bill less, you'll get a lower payment. The $18,000 is the initial year's bonus only.

Eligibility

Eligibility is the next consideration, because not all dermatologists are eligible for the programs. For Medicare, the list of eligible professionals is limited to physicians, so dermatologists (as well as all doctors of medicine and osteopathy) can participate.

Because the payment is tied to a percentage of allowed charges, your participation doesn't hinge on the volume of Medicare patients you see - or the percentage of your practice spent seeing them.

Medicaid expands the definition beyond physicians - midlevel providers such as nurse practitioners and select physician assistants are also eligible. The catch with Medicaid? Eligibility requires that a minimum of 30 percent of the provider's patient encounters are Medicaid.1 This bar is set fairly high, but the government gave the green light to include Medicaid beneficiaries from any state, those with Medicaid as a secondary payer and patients covered by traditional Medicaid or Medicaid managed care.

Remember, too, if you reach 30 percent, you automatically qualify for the entire bonus.