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Medicare
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Medicaid
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Program eligibility linked to patient volume
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No.
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Yes. Requires patient volume of 30 percent attributable to Medicaid for nonhospital-based physicians, 20 percent for pediatricians.
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Program incentives linked to allowable charges
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Yes. Medicare incentives are based on 75 percent of allowable charges up to the maximum amounts specified for each year.
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No. Medicaid incentives are based on 85 percent of allowable EMR implementation costs in the first year ($25,000 cap) and 85 percent of allowable operational costs in subsequent years ($10,000 cap/year).
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Funds received before achieving meaningful use
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No. Requires physicians to purchase or lease EMR system and have it fully integrated to "meaningful use" before eligible for funding.
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Yes. Physicians can qualify for a one-time payment in the first year by implementing or upgrading to a certified EMR.
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Maximum incentive in year one
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$18,000
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$21,250
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Incentives in following years
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$12,000, $8,000, $4,000, and $2,000 for the next four years respectively for those starting to receive benefits in 2011 and 2012.
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Once "meaningful use" is met, physicians are eligible for up to $8,500 a year.
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Maximum incentives
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$44,000 for most physicians over a five-year period.
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$63,750 over a six-year period. Pediatricians who meet the 20 percent requirement are limited to $42,500.
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Earliest starting date
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Jan. 1, 2011
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Jan. 1, 2011
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Latest start date to maximize incentives
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Sept. 30, 2012
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Sept. 30, 2016
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Incentive end date
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The last year to qualify to meet "meaningful use" is 2014; the last payment is made in 2016.
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The last year to qualify for incentives is 2016; the last payment is made in 2021.
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Eligible for participation
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Physician (MD or DO), doctor of dental surgery or dental medicine, doctor of podiatric medicine, doctor of optometry, or chiropractor, authorized to practice under state law.
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Physicians, dentists, nurse practitioners, certified nurse midwives, and physician assistants practicing predominantly in a federally qualified health center or rural health clinic (FQHC/RHC).
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Penalties for not demonstrating meaningful use
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Yes. Medicare payments to physicians begin decreasing in 2015 by 1 percent, by 2 percent in 2016, by 3 percent for 2017. Possible cuts will continue to 5 percent by 2019 if 75 percent of office-based physicians have not achieved meaningful use.
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No. There are no penalties.
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Is it possible to switch programs?
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Yes. It is possible to switch between Medicare and Medicaid incentive programs one time. The last payment year a switch can occur is 2014.
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Is it possible to qualify for both programs?
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No. There is no dual eligibility between programs.
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