Back to top

Understanding the Difference Between Medicare And Medicaid Incentive Programs

Coding Corner

The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.

Understanding the Difference Between Medicare And Medicaid Incentive Programs
The Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs provide incentive payments to eligible professionals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. With the exception of dually-eligible hospitals, providers can only participate in one of the two EHR incentive programs. There are a few key differences between the two programs. The Medicare EHR Incentive Program allows for the following: participation can begin as early as 2011; eligible professionals can receive up to $44,000 over five years; receipt of the maximum incentive requirement requires participation beginning in 2012; failure to demonstrate meaningful use by 2015 or later will result in a reduction in reimbursement. The Medicaid EHR Incentive Program allows for the following: voluntary participation offered by individual states that may begin as early as 2011 depending on your state; eligible professionals can receive up to $63,750 over the six years; there are no reductions in Medicaid reimbursement for failure to demonstrate meaningful use. In the end, demonstration of meaningful use of certified EHRs can enhance your practice’s bottom line. Additional general information on the EHR incentive program is available at www.cms.gov/EHRIncentivePrograms/.