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Medicaid vs Medicare


 
 

For eligible providers there is a difference between the Medicare EHR Incentive and the Medicaid EHR Incentive programs.

 

The Medicare EHR Incentive Program, administered by CMS, will provide incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology.


The Medicaid EHR Incentive Program, administered at the state-level, will provide incentive payments to eligible professionals, eligible hospitals, and CAHs as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their first year of participation and demonstrate meaningful use for up to five remaining participation years.

 

Below is a quick comparison between the two programs to assist eligible providers.



Medicaid vs. Medicare Comparison Chart

  Medicaid Medicare

Total Incentive

Up to $63,750 Up to $44,000

Total Years

6 5

First Year's Payment

$21,500 $18,000 (for 2011 or 2012)

Subsequent Years

$8,500/year Steps down from $12,000 to $2,000

Patient Volume Reqs

Significant Medicaid
patient volume
Proportional to Part B
Allowable Claims

Adopt/Implement/Upgrade

Year 1 only No

Meaningful Use

Years 2-6 All years

Continuous Participation

No Yes

Eligible Provider Types

Physician, Nurse Practitioner, Dentist,
Physician Assistant* (under special circumstances)
Doctor of medicine or osteopathy, Doctor of oral surgery or dental medicine, Doctor of podiatric medicine, Doctor of Optometry, Chiropractor

 

As a provider for the Medicare and Medicaid EHR Incentive Program go here.

 

EHR Flowchart 

Hospitals may receive incentive payments in the same payment year from both Medicaid and Medicare if they meet all eligibility criteria.

 

For more information on the Medicare EHR Incentive Program, please visit the Center for Medicare and Medicaid Services website.