How do I know if my colleagues and I are eligible providers?

You can choose one of two incentive programs, and the provider eligibility requirements are slightly different in each.

The Medicare incentive program is open to:

  • MDs or DOs
  • DMDs or DDSs
  • Doctors of podiatry
  • Doctors of optometry
  • Chiropractors

If you're in a group practice, each provider can be eligible for the full $44,000 reimbursement, but each provider can claim the reimbursement at only one practice. Also, if you treat more than 90% of your patients in an inpatient hospital setting or an ER, you don't qualify for the reimbursement as a provider. (Most likely, your hospital is claiming the reimbursement.)

The Medicaid program is open to:

  • MDs or DOs
  • DMDs or DDSs
  • NPs
  • certified nurse-midwives
  • PAs who work in Federally Qualified Health Centers or Rural Health Clinics led by a PA

For the Medicaid program, at least 30% of your patients need to be Medicaid patients. (The cutoff is 20% for pediatricians.) Alternatively, you can meet the patient mix requirement if you work in a Federally Qualified Health Center or Rural Health Clinic and at least 30% of your patients are needy.

While the Medicare reimbursements are available to providers throughout the country, not all states are at the same point with respect to offering Medicaid reimbursement programs. You can check on the status of your state here: http://www.cms.gov/apps/files/statecontacts.pdf

If you qualify for both the Medicare and Medicaid programs, you have to pick one of them for the reimbursements. Sorry, no double dipping.

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