General FAQs
Eligibility
Specialties
FQHCs
Q. Are providers allowed to participate in both the Medicare & Medicaid programs?
A. No, you may only participate in one or the other.
Q. Can multispecialty groups have some physicians participate in the Medicare incentive and some participate in the Medicaid incentive?
A. Yes. Incentives will be paid to eligible professionals on an individual, per-provider basis. That means that one provider in a group can elect to participate in the Medicare program while another in the same practice can elect to participate in the Medicaid program (provided s/he meets the Medicaid patient volume threshold requirements).
Q. How do you make the choice between Medicare and Medicaid program and notify them?
A. It is ultimately your decision, however, you may want to consider that the Medicaid program is a higher bonus payment, if you are eligible. Details of the attestation process for Medicaid have not yet been released.
Q. Our Medicare and public aid patients are less than 5%of our patients will this be worth trying to qualify?
A. You will not be able to qualify for the Medicaid program (which requires 30% patient volume, with the exception of 20% for pediatricians), however, you should consider participation in Medicare. The Medicare bonus payment program will pay 75% of your total allowed charges.
Q. How do we make the Program selection and with who?
A. You must register for the program you wish to participate in. Medicare registration will be online at http://cms.gov/EHrIncentivePrograms. States will be rolling out their own registration processes in the coming months. All Medicare EPs must have a National Provider Identifier (NPI), and be enrolled in the CMS Provider Enrollment, Chain and Ownership System (PECOS) to participate in the EHR incentive program. Most will also need an active user account in the National Plan and Provider Enumeration System (NPPES). CMS will use these systems' records to register for the program and verify Medicare enrollment prior to making Medicare EHR incentive program payment/ NOTE: Medicaid EPs who are only participating in the Medicaid EHR incentive program are not required to enroll in PECOS.
Q. I was told that the stimulus money is based on the percentage of your practice that is Medicare. So if you have a patient base of 25% Medicare you will only receive 25% of the $44,000?
A. Medicare payments will be calculated on an individual-Professional basis. For each year under the incentive program, an EP will receive 75 percent of the EP’s total “allowed charges” (that is, the amounts Medicare pays under the PFS during the Payment Year). For the first payment year, in order to qualify for the total incentive amount of $18,000, an eligible professional would need at least $24,000 in Medicare billing ($24,000 - 75% = $18,000). Providers billing less than $24,000 in Medicare charges would receive 75% of that lesser total Medicare billing for the year. Note, the first year payment cap is $18,000 and the incentive amounts scale down each year.
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The information in this FAQ was produced and provided by Manatt Health Solutions.
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