For Medicare participants, the potential incentive is now a maximum of $39,000, and will be paid out over the next 4 years. Physicians practicing in a Health Professional Shortage Area (HPSA) are eligible for an additional 10%.
For the provider’s first payment year, he/she must demonstrate meaningful use for any 90-day period. (All subsequent years—except 2014—require a full year of meaningful use.) Providers who began their first meaningful use reporting period by October 3, 2012 stand to receive the maximum amount of money.
In 2015, a 1% reduction “adjustment” to Medicare reimbursement is scheduled to go into effect for non-meaningful users, increasing to 2% in 2016, and 3% in 2017. To avoid the 2015 penalty, providers can successfully demonstrate meaningful use in 2013 or at the latest, by October 1, 2014.
For Medicaid participants, the potential incentive is a maximum of $63,750, and is paid out over 6 years ($42,500 for pediatricians with 20%-30% Medicaid). The first year does not require demonstration of meaningful use, but can be reimbursement for adoption, implementation, or upgrading to a certified EHR.
Payment Year and Incentive
There is no penalty for non-participation under Medicaid, but any Medicare revenue generated by a provider who fails to demonstrate meaningful use would be subject to adjustment.
Read more about the differences between the Medicare and Medicaid incentive programs.