Medicare and Medicaid EMR Incentive Comparison

Physicians are eligible for bonus payments from Medicare or Medicaid for the meaningful use of an electronic medical record (EMR). Eligibility and program administration differ between the programs. This chart is a quick overview to help physicians decide which program is most suitable for their practice.

Medicare

Medicaid

Program eligibility linked to patient volume

No.

Yes. Requires patient volume of 30 percent attributable to Medicaid for nonhospital-based physicians, 20 percent for pediatricians.

Program incentives linked to allowable charges

Yes. Medicare incentives are based on 75 percent of allowable charges up to the maximum amounts specified for each year.

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).

Funds received before achieving meaningful use

No. Requires physicians to purchase or lease EMR system and have it fully integrated to "meaningful use" before eligible for funding.

Yes. Physicians can qualify for a one-time payment in the first year by implementing or upgrading to a certified EMR.

Maximum incentive in year one

$18,000

$21,250

Incentives in following years

$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.

Once "meaningful use" is met, physicians are eligible for up to $8,500 a year. 

Maximum incentives

$44,000 for most physicians over a five-year period.

$63,750 over a six-year period.  Pediatricians who meet the 20 percent requirement are limited to $42,500.

Earliest starting date

Jan. 1, 2011

Jan. 1, 2011

Latest start date to maximize incentives

Sept. 30, 2012

Sept. 30, 2016

Incentive end date

The last year to qualify to meet "meaningful use" is 2014; the last payment is made in 2016.

The last year to qualify for incentives is 2016; the last payment is made in 2021. 

Eligible for participation

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.

Physicians, dentists, nurse practitioners, certified nurse midwives, and physician assistants practicing predominantly in a federally qualified health center or rural health clinic (FQHC/RHC).

Penalties for not demonstrating meaningful use

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. 

No. There are no penalties. 

Is it possible to switch programs?

Yes. It is possible to switch between Medicare and Medicaid incentive programs one time. The last payment year a switch can occur is 2014. 

Is it possible to qualify for both programs?

No. There is no dual eligibility between programs. 

 

Medicare and Medicaid EMR Incentive Timelines

The following charts outline the timeline of incentives available to qualifying physicians under Medicaid and Medicare.  Physicians in Health Provider Shortage Areas (HPSA) may qualify for an extra 10% in EMR incentives.

Medicaid Maximum Incentives for EMR Users (85% of the cost of purchasing and implementing EMR)

Adopt in 2011

Adopt in 2012

Adopt in 2013

Adopt in 2014

Adopt in 2015

Adopt in 2016

2011

 $21,250

2012

 $8,500

 $21,250

2013

 $8,500

 $8,500

 $21,250

2014

 $8,500

 $8,500

 $8,500

 $21,250

2015

 $8,500

 $8,500

 $8,500

 $8,500

 $21,250

2016

 $8,500

 $8,500

 $8,500

 $8,500

 $8,500

 $21,250

2017

 $8,500

 $8,500

 $8,500

 $8,500

 $8,500

2018

 $8,500

 $8,500

 $8,500

 $8,500

2019

 $8,500

 $8,500

 $8,500

2020

 $8,500

 $8,500

2021

 $8,500

TOTAL

 $63,750

 $63,750

 $63,750

 $63,750

 $63,750

 $63,750

 

Medicare Maximum Incentives for Meaningful EMR Users

Adopt in 2011

Adopt in 2012

Adopt in 2013

Adopt in 2014

Adopt in 2015

Adopt in 2016

2011

 $18,000

2012

 $12,000

 $18,000

2013

 $8,000

 $12,000

 $15,000

2014

 $4,000

 $8,000

 $12,000

 $15,000

2015

 $2,000

 $4,000

 $8,000

 $12,000

2016

 $2,000

 $4,000

 $8,000

TOTAL

 $44,000

 $44,000

 $39,000

 $35,000

 $-  

 $-  


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