Skip to Main Content

Program FAQs 

Submit a Question

Do you have a question for HFS? If so, please email us at hfs.ehrincentive@illinois.gov

CMS FAQs

CMS has compiled an extensive list of frequently asked questions regarding the EHR Incentive Program. Providers should visit that list for any questions not answered here.

eMIPP Frequently Asked Questions

Select the Frequently Asked Question to view the answer.

  1. What is the definition of Pediatrician for this program?

    Pediatricians demonstrating 30% or greater Medicaid patient volume will be treated identical to other physicians for the purposes of this program and will receive the full incentive if eligible. Pediatricians demonstrating 20-29% Medicaid patient volume will be entitled to receive 2/3 of the incentives, if eligible.

  2. What is the difference between the meaningful use reporting period and the patient volume reporting period?

    Eligible Professionals

    Eligible Hospitals
  3. What are the requirements for Stage 1 of Meaningful Use in 2013?

    In 2013, meaningful use includes core set objectives, menu set objectives and Clinical Quality Measures (CQMs) that are specific to eligible professionals or eligible hospitals and CAHs.

    Eligible Professionals

    There are a total of 67 meaningful use objectives. To qualify for an incentive payment, the specified combination totaling 24 of these 67 objectives must be met:

    Eligible Hospitals

    There are a total of 37 meaningful use objectives. To qualify for an incentive payment, the specified combination totaling 32 of these 37 objectives must be met:

  4. Which year requires demonstration of meaningful use?
    Federal CMS has developed a Timeline tool to assist providers in understanding the timing of the program and when to report meaningful use. Please refer to this timeline tool for assistance.
  5. What is required to report the Clinical Quality Measures in 2013?

    In addition to meeting the core and menu objectives, eligible professionals, eligible hospitals and CAHs are also required to report clinical quality measures.

    To learn more about individual clinical quality measures for eligible professionals, eligible hospitals and CAHs, visit our Clinical Quality Measures page or the CMS website.

  6. How is patient volume calculated for groups?

    EPs may use a clinic or group practice's patient volume as a proxy for their own under three conditions:

    The clinic or practice must use the entire practice's patient volume and not limit it in any way. EPs may attest to patient volume under the individual calculation or the group/clinic proxy in any participation year. Furthermore, if the EP works in both the clinic and outside the clinic (or within and outside a group practice), then the clinic/practice level determination includes only those encounters associated with the clinic/practice.  The following is an example of how an EP would use the group patient volume method:

    Examples below:

    Example #1

    Dr. Sue, a physician practicing in pediatrics, works for ZZ Clinic, YY Clinic and individually. She alone has 19% patient volume therefore does not qualify for the program. 

    Professional Provider Type Medicaid Encounters All Encounters Patient Volume %
    Ms. Leigh Dietician 50 100 50
    Dr. Tom Physician 34 100 34
    Dr. Sue Pediatrician 19 100 19
    Dr. Bob Pediatrician 20 100 20
    Total   123 400 31

    In the example above the pediatricians are part of a group and if you aggregate all of the Medicaid encounters and divide by the number of members you can arrive at the group volume of 123/400 = 31% Medicaid Patient Volume. 

    In this example, the group maximized their benefits. Each member of the group would attest to 123 Medicaid encounters and 400 for all encounters allowing all providers in the group to attest to 30% Medicaid volume. Notice in the example above, it is appropriate when using group encounter methodology to include all licensed professionals regardless of eligibility for the program. Dieticians are excluded from participation; however their encounters can be used in calculating group volume.

    Summary:

    The practice maximized their benefits:

    1. The practice was allowed to use all the providers encounters
    2. Ms. Leigh is not eligible for the program, but her encounters are able to be used in the group methodology
    3. Dr. Tom could have attested as an individual and received the same year 1 incentive of $21,250 because he has more than 30% Medicaid Patient Volume.
    4. Dr. Sue would have not been eligible, but based on the calculation can attest and receive the full incentive of $21,250 in her first year of participation.
    5. If Dr. Bob would have attested individually he would have received $14,167 in their first year of the program. By utilizing the group methodology he can receive $21,250.

    Example #2

    Dr. Pete is part of a large group practice with multiple locations consisting of providers that serve some Medicaid and providers that are enrolled but see no Medicaid patients. If the practice calculates the patient volume individually they have wildly varying results from 100% to 10% and would only be eligible for 70% of the clinics professionals. The practice includes professionals that are eligible for the program and some that are not. If the practice calculates the combined total of the group's patient volume based on Payee Tax ID and reaches 30% or more Medicaid utilization, then it is acceptable to use the entire practice's patient volume when attesting. This is the easiest method for HFS to validate.

  7. How is patient volume calculated for EPs practicing predominantly in an FQHC or RHC?
    EPs practicing predominantly in an FQHC or RHC will be evaluated according to their “needy individual” patient volume. To be identified as a “needy individual,” patients must meet one of following criteria: (1) received medical assistance from Medicaid or the CHIP; (2) were furnished uncompensated care (Charity Care) by the provider; or (3) were furnished services at either no cost or reduced cost based on a sliding scale determined by the individual’s ability to pay.
  8. Which program should I choose, Medicare or Medicaid?

    The EHR Incentive Programs are available for Medicare and Medicaid eligible professionals, eligible hospitals, and critical access hospitals (CAHs). Although most hospitals will be able to receive a payment from both programs, eligible professionals must choose which program they want to participate in. The two programs are similar in many ways, however there are some important differences.

    Medicare EHR Incentive Program Medicaid EHR Incentive Program
    Run by CMS Run by Your State Medicaid Agency
    Maximum incentive amount is $44,000 Maximum incentive amount is $63,750
    Payments over 5 consecutive years Payments over 6 years, does not have to be consecutive
    Payment adjustments will begin in 2015 for providers who are eligible but decide not to participate No Medicaid payment adjustments. (Note: Providers enrolled in Medicaid EHR Incentive Program who are "eligible for Medicare" may still have Medicare adjustments if not MU by required dates)
    Providers must demonstrate meaningful use every year to receive incentive payments. In the first year providers can receive an incentive payment for adopting, implementing, or upgrading EHR technology. Providers must demonstrate meaningful use in the remaining years to receive incentive payments.