Yes, there is money out there in the form of Medicare and Medicaid incentives!

Okay, so what’s the catch? Meaningful Use. By now most providers, and their staff, are quite familiar with this term. Meaningful Use is a set of criteria established by CMS that must be met using a certified ERH (electronic health record) system in order for eligible providers to receive incentive payments. The ultimate goal of Meaningful Use is to improve patient care and most providers are already meeting most of these quality standards. It is now a question of recording these measures as structured data and providing CMS with the results via an online “attestation”.

Meaningful Use criteria is the same whether a provider is going for the Medicare or Medicaid incentive. There are 10 Core Measure all of which must be met and 10 Menu Measures of which 5 must be met. Some of these measures do have exclusions that can be claimed. In addition, there are Clinical Quality Measures that must be met. The path to payment, and the payment amounts, however, differ in the Medicare and Medicaid programs.

For Medicare providers, their first year of participation requires a 90 consecutive day period in which they must meet the criteria. Second year of participation requires a full 365 days of meeting criteria.If their first year was 2011 or is 2012 they can receive up to a total of $44,000 over a 5 year period of time. Their first payment can be up to $18,000 and this is based on 75% of $24,000 in Medicare Part B charges. If they do not have a total of $24,000 for the year, they can still receive 75% of whatever amount the Part B charges were.

Some providers will not start their first year participation until 2013. This can be due to delayed decision of which certified software to adopt, or delays in implementation and other factors. In this case, their first payment would only be $15,000 and they would lose the last year’s participation payment of $2,000. Starting in 2014 brings total payments down even further, and if they wait until 2015, there is no reimbursement. Most important for Medicare providers to remember is that if they do not achieve Meaningful Use by 2015, there will be a payment adjustment to their Medicare reimbursement of 1% and this payment adjustment increases in subsequent years to a maximum of 5%. In order to avoid the 2015 payment adjustment the provider must attest no later than Oct 1, 2014 which means they must begin their 90 day EHR reporting period no later than July 2, 2014.

The good news for Medicaid eligible providers is that in their first year of participation they need only attest, through documentation, to having a certified EHR in place and they can receive $21,250 in that first year. Subsequent years, they will also have to meet the criteria that Medicare providers must meet in order to receive further payments. Each payment after the initial payment is $8,500 and over a 6 year period of time their total reimbursement can be $63,750.

The Medicaid program is not based on charges submitted but rather on the percentage of Medicaid encounters within a 90 day period the previous year. In other words, if a provider wants to attest in 2012, documentation must be provided to AHCA showing that in 2011 during any 90 day period, of all encounters, at least 30% were Medicaid. Pediatricians need only have 20%, however, they will only receive a portion of the reimbursement if that is the case. Another difference in the programs is that Medicaid providers do not have to participate every year. They can skip a year without any penalty which is something Medicare providers cannot do. The Medicaid program runs through 2021 so a provider could start as late as 2016 and still receive full reimbursement.

There might have been some hesitation and trepidation at the onset of the EHR Incentive Program. Why should I adopt an EHR?? Again, the purpose of an EHR is to improve the quality of patient care. EHRs give one record of a patient’s health information enabling better coordination of health care. The ultimate goal being sharing of data provider to provider and provider to hospital, hospital to provider.

Is the money really there?? According to the GAO, spending for the Medicare and Medicaid EHR incentive programs is estimated to total $30 billion from 2011 through 2019. In June the Department of Health & Human Services (HHS) reported that more than 110,000 eligible health care providers had been paid more than $5.7 billion.

The University of Central Florida Regional Extension Center is a valuable resource to help providers achieve Meaningful Use and receive the incentive. Being a member of the REC also provides a myriad of other benefits, but helping you receive the incentive is first and foremost. For more information please go to our website

Now, let’s go grab a chunk of that money!


Carol Carpenter
Account Manager
UCF College of Medicine
Regional Extension Center