Eligible Professionals

Are you an Eligible Professional?

CMS User Guide – An Introduction to the Medicare EHR Incentive Program for Eligible Professionals
CMS User Guide – An Introduction to the Medicaid EHR Incentive Program for Eligible Professionals

Medicare Eligible professionals:

  • Doctor of medicine or osteopathy
  • Doctor of dental surgery or dental medicine
  • Doctor of podiatry
  • Doctor of optometry
  • Chiropractor

Medicaid Eligible professionals:

  • Physicians (primarily doctors of medicine and doctors of osteopathy)
  • Nurse practitioner
  • Certified nurse-midwife
  • Dentist
  • Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.

Medicaid EPs must meet one of the following criteria:

  • Have a minimum 30% Medicaid patient volume*
  • Have a minimum 20% Medicaid patient volume, and is a pediatrician*
  • Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals

My EHR Participation Timeline

Use this web-based interactive tool to determine your participation timeline for each stage of Meaningful Use.

Calculating Patient Volume

A State must submit through the State Medicaid information health plan (SMHP) the option or options it has selected for measuring patient volume. A State must select either or both methodologies described in the final rule.

Methodology –  patient encounter.

  • EPs. To calculate Medicaid patient volume, an EP must divide:
    • The total Medicaid patient encounters in any representative,continuous 90-day period in the preceding calendar year; by
    • The total patient encounters in the same 90-day period.

Methodology – patient panel.

  • EPs. To calculate Medicaid patient volume, an EP must divide:
    • The total Medicaid patients assigned to the EP’s panel in any representative, continuous 90-day period in the preceding calendar year when at least one Medicaid encounter took place with the Medicaid patient in the year prior to the 90-day period; plus Unduplicated Medicaid encounters in the same 90-day period;by
    • The total patients assigned to the provider in that same 90-day period with at least one encounter taking place with the patient during the year prior to the 90-day period; plus All unduplicated patient encounters in the same 90-day period.

Establishing an alternative methodology.

A State may submit to CMS for review and approval through the SMHP an alternative from the options included above, so long as it meets the following requirements:

  1. It is submitted consistent with all rules governing the SMHP at § 495.332 of the final rule.
  2. Has an auditable data source.
  3. Has received input from the relevant stakeholder group.
  4. It does not result, in the aggregate, in fewer providers becoming eligible than the methodologies outlined above.

Meaningful Use