Roles

Individual Eligible Professional (EP)

A single provider who will enter their data and submit their own CMS EHR funding application.

Eligible Hospital Representative (EH)

A representative for a hospital who will enter the hospital data and submit the hospital’s CMS EHR funding application.

Group Administrator (Group)

A representative for a group or clinic who will enter data for the group and enter data on behalf of individual providers associated with the group/clinic.

Group Volumes

Under the rules of the program, Groups and Clinics can use group volumes to determine eligibility for all providers associated with the group/clinic. In order to use the group volumes, all practitioners within the group must agree to use the group volumes to determine Medicaid patient volumes and eligibility to participate in the program. If one provider in the group/clinic chooses to use individual patient volumes rather than the group volumes, all other providers in the group must also use individual patient volumes.

Before starting the entry process, you should work with the providers in your group to get agreement to use the group Medicaid volumes before you start the process of entering information in the system. This will help make the process of entering information for your group go more smoothly.

Patient Volumes

Eligible Professionals (EPs)

Eligible Professionals must demonstrate 30% Medicaid patient volumes for a representative 90-day period in the previous calendar year. Pediatricians may demonstrate a minimum of 20% Medicaid patient volumes to qualify for a reduced incentive amount.

Patient volumes are based on unique patient encounters per day for the 90-day period. In certain circumstances, you may also be able to count Medically Needy patient volumes to help you meet the eligibility requirements.

Your patient volume information must come from an auditable data source, so you must be able to provide documentation that supports your volumes if requested.

Patient Volumes

Eligible Hospitals (EHs)

Eligible Hospitals must demonstrate 10% Medicaid discharges in the previous fiscal year. Your patient volume information must come from your hospital Cost Report.

Patient Volumes

Group Administrators (Groups)

Groups may demonstrate 30% Medicaid patient volumes for a representative 90-day period in the previous calendar year. Group volumes must include all practitioners in the group to determine eligibility.

Patient volumes are based on unique patient encounters per day for the 90-day period. In certain circumstances, you may also be able to count Medically Needy patient volumes to help you meet the eligibility requirements.

Your patient volume information must come from an auditable data source, so you must be able to provide documentation that supports your volumes if requested.

Adopt

Acquire, purchase or access to certified EHR technology. Evidence of actual acquisition or installation of the technology is required to demonstrate adoption.

Implement

Install or commence utilization of certified EHR technology capable of meeting meaningful use requirements; including staffing, maintenance, and training. Evidence of actual installation and use is required to demonstrate implementation.

Upgrade

Expand the available functionality of EHR technology capable of meeting meaningful use requirements; including, addition of decision support modules, establishment of interfaces for HIE, etc. Evidence that the provider has expanded the functionality of existing EHR technology is required to demonstrate upgrade.