General FAQs
Medicare & Medicaid
Specialties
FQHCs
Q. Are only physicians allowed to participate in the Medicare incentive plan?
A. For the Medicaid program, eligible professionals are physicians (defined as M.D.s and Osteopaths and in some limited cases Optometrists), dentists, certified nurse midwives, nurse practitioners, and physician assistants who are practicing in federally qualified health centers (FQHCs) or rural health clinics (RHCs) led by a physician assistant. For the Medicare program, eligible professionals are doctors of medicine or osteopathy, doctors of dental surgery or medicine, doctors of podiatric medicine, doctors of optometry and doctors of chiropractic medicine. Physical therapists are not considered.
Q. What happens if we begin the process of switching to EHR and a new associate joins our practice? Can they start participating in the incentive program at that point or do they need to start the process from the beginning?
A. Eligible professionals can be added during the program.
Q. Are there any restrictions to hospital-owned physician/provider practices?
A. "Hospital-Based" Eligible Professionals - In general, Hospital-Based EPs are not eligible to participate in the EHR incentive programs. A Hospital-Based EP is defined as an EP who “furnishes substantially all of his or her [covered services] in a hospital setting and through the use of the facilities and equipment, including the qualified [EHR], of the hospital." An EP will be considered to be a hospital-based EP if more than 90 percent of the EP’s services covered under the relevant program (that is, Medicare or Medicaid) are billed using the following two place of service (“POS”) codes for HIPAA standard transactions: 21 - Inpatient Hospital and 23 - Emergency Room.
Q. We are a practice of 8 eligible providers. I have a few providers who will not participate. Are those providers who do wish to participate still eligible for payment?
A. Yes, they are still eligible.
Q. If we have more than one doctor in our group, can we apply for both Medicare and Medicaid using each Doctor? I am a billing service and I bill for a psychiatrist and psychologists.
A. A billing service is not eligible for incentive funds. Eligible professional incentives are paid on an individual basis so yes, providers in the same practice can participate in different incentive programs.
Q. I have some confusion regarding the "Eligible Provider" and definition regarding "hospital based". I have surgeons who bill their surgeries with a facility code of the hospitals and not their office. What do you know about this?
A. "Hospital-Based" Eligible Professionals - In general, Hospital-Based EPs are not eligible to participate in the EHR incentive programs. A Hospital-Based EP is defined as an EP who “furnishes substantially all of his or her [covered services] in a hospital setting and through the use of the facilities and equipment, including the qualified [EHR], of the hospital." An EP will be considered to be a hospital-based EP if more than 90 percent of the EP’s services covered under the relevant program (that is, Medicare or Medicaid) are billed using the following two place of service (“POS”) codes for HIPAA standard transactions: 21 - Inpatient Hospital and 23 - Emergency Room.
Q. If one physician in a group of five is not using EHR, will only that physician get the reduction in reimbursment in 2015?
A. Yes, that is correct.
Q. Eligible professionals through the Medicare program according to your white paper are limited to physicians. Are mid level providers only eligible through the Medicaid program?
A. Yes, that is correct - mid-level providers are only eligible through the Medicaid program.
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The information in this FAQ was produced and provided by Manatt Health Solutions.
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