Eligible Professionals

The following are considered eligible professionals (EPs):

  • Non-hospital based Doctors of Medicine (MDs) and Doctors of Osteopathy (DOs)
  • Dentists
  • Nurse Practitioners
  • Certified Nurse Midwives

An eligible professional is considered hospital based if 90% or more of their encounters occur at an inpatient or emergency room setting.

Patient Threshold Requirements:

In order to participate in the Medicaid EHR Incentive Payment Program, eligible professionals must meet a minimum Medicaid Patient Volume Threshold each year of participation:

  • 30% Medicaid Patient Volume Threshold over a continuous 90 day period from the previous calendar year.
  • 20% Medicaid Patient Volume Threshold for pediatricians over a continuous 90 day period from the previous calendar year.

A Children’s Health Insurance Program (CHIP) reduction factor of 2.89% must be applied to an eligible professional’s in-state Medicaid Patient Volume in order to fulfill a CMS requirement stating that CHIP patients may not be included in Medicaid Patient Volume.

Incentive Payments:

Eligible professionals may receive up to $63,750 in incentive payments over a 6 year period. In the first year of participation, eligible professionals may qualify for $21,250 in incentive payments. For each subsequent year of participation, they may receive up to $8,500. Pediatricians with a minimum 20% Medicaid Patient Volume Threshold may receive up to $42,500 in incentive payments over a 6 year period. In the first year of participation, eligible professionals may qualify for up to $14,167 in incentive payments. For each subsequent year of participation, they may receive up to $5,667.Pediatricians that meet or exceed the 30% Medicaid Patient Volume Threshold are eligible for the full incentive amount.

In order for eligible professionals to take advantage of the full incentive amount, they must register for the Medicaid EHR Incentive Payment Program no later than 2016.

For more helpful information regarding eligibility requirements for Eligible Professionals, please visit the Tools & Resources section of the website.