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Am I Eligible? 

 

Determine Your Eligibility

The first step in EHR Incentive Program enrollment is determining eligibility.  There are numerous resources available to assist in determining your eligibility. They are:

Eligibility Questions

Your responses to the questions below will help determine your eligibility:

Eligible Professional (EP)

  1. Have you signed a contract, purchased or installed an ONC Certified Electronic Health Record System?
  2. In any 90 consecutive days during the preceding calendar year or twelve months prior to the attestation date, did you or your practice have at least 30% of your patient encounters paid by HFS? Or 30% of patient encounters across one or multiple practices paid by HFS (>=20% for Pediatricians)? This percentage is also known as Medicaid Utilization.
  3. Are more than 10% of your services performed outside of a hospital setting (Services billed as (Place of Service Code 21) or emergency room (Place of Service Code 23))?
  4. Are you one of the provider types below, with a currently active Illinois Medicaid enrollment and in good standing with HFS?

If you answered YES to any of the above, you may be eligible for the Medicaid Incentive Payment. You are encouraged to use Federal CMS’s Eligibility tool to further determine if you are eligible.

Eligible Hospitals

  1. Have you signed a contract, purchased or installed an ONC Certified Electronic Health Record System?
  2. In any 90 days during the preceding Federal Fiscal year or previous 12 months, did the hospital have at least 10% of its patient encounters paid by HFS?
  3. Are the last four digits of the hospital’s CMS Certification Number (CCN) in the range 0001-0879 or 1300-1399?

If you answered YES to all of the questions above, you may be eligible for the Medicaid and additionally, the Medicare Incentive Payment. You are encouraged to use Federal CMS’s Eligibility tool to further determine if you are eligible.  

Establishing Patient Volume

One key aspect of eligibility is patient volume. To qualify for an incentive payment under the Illinois EHR Medicaid Incentive Payment Program, an eligible professional must meet one of the following criteria for Medicaid patient volume:

To calculate Medicaid patient volume, an EH must divide:

Types of Encounters to Report as Medicaid Encounters

Eligible Professional (EP)

EP Practicing Predominantly* in an FQHC/RHC

*For this program, practicing predominantly in an FQHC/RHC means 50% or more of the total patient volume for the EP over a six-month period is at an FQHC/RHC

Group Practices

Clinics or group practices will be permitted to calculate patient volume at the group practice/clinic level only in accordance with all of the following limitations:

For purposes of calculating eligible hospital patient volume, a Medicaid encounter is defined as services rendered to an individual 1) per inpatient discharge, or 2) on any one day in the emergency room where HFS paid for:

Exception – a children’s hospital is not required to meet Medicaid patient volume requirements.

Payment Prerequisites

The items listed below can prohibit a provider from receiving an incentive payment. Please ensure you have met the prerequisites below:

  1. The Provider must be enrolled as an HFS provider and in good standing with the department.
    1. For enrollment information, visit the Provider Enrollment section of the HFS Medical Programs website.
  2. The payee tax identification number (TIN) designated during registration at the CMS Registration and Attestation Web site must represent a valid certified payee on file with HFS for the provider completing the attestation.
    1. Providers can verify the payee TIN by reviewing their Provider Information Sheet. Corrections can either be made at the Federal CMS Registration and Attestation website by changing to a certified payee listed on their Provider Information Sheet or by contacting the Bureau of Comprehensive Health Services, Provider Participation Unit at 217-782-0538 for further assistance.
  3. The Provider or hospital must be an eligible provider type to participate in the Illinois EHR Medicaid Incentive Payment Program, which include:

EP Type and Specialty

EH Type and Specialty

Once providers have ensured that all necessary prerequisites have been met, they may proceed with Registration and Attestation.

Step 2 – Register with CMS