HITECH and Meaningful Use

Differences between the Medicaid and Medicare Plans

Are there differences between the Medicaid and Medicare programs?

There are notable differences between the Medicaid and Medicare options that eligible providers (EPs) should become familiar with before choosing the plan that they will utilize. The plan selected should be in the best interest of their practice and their patients. The differences are summarized in the table below.¹

Differences between the Medicaid and Medicare Plans

Medicaid	Medicare
Voluntary for states to implement	Federal government will implement
No Medicaid fee schedule reductions	Medicare fee schedule reductions begin in 2015 for physicians who are not meaningful use (MU) users
Adoption, Implementation, Upgrading (AIU) option is for Medicaid only	Medicare must begin with MU in year 1
Maximum incentive for EPs is $63,750	Maximum incentive for EPs is $44,000
States can make adjustment to MU	MU will be common for Medicare
May appeal decisions	Appeals process needs to be developed
Program sunsets (ends) in 2021; last year a provider may initiate the program is 2016	Program sunsets (ends) in 2016; fee schedule reductions and market basket update begin 2015
Five EPs, two general types of hospitals (includes critical access hospitals (CAHs)	Only physicians, subsection (d) hospitals and CAHs

Which program is right for me?

EPs must select to participate in Medicare OR Medicaid and may switch once between programs before 2015. If an EP elects to participate in the Medicaid program they must select one state for payments and may change states once each year.^2,3

There will be federal and state systems for disbursement of the EP incentive funds. The States will connect to the federal repository to continue provider registration at the State level and continue eligibility verification. After cross checking for potential duplicative or inappropriate payments, the States will then disburse payment to ONE eligible Taxpayer Identification Number (TIN) and notify the national repository that payment was disbursed. States will also ask each EP for additional information to make accurate and timely payments. This additional information will include patient volume, state licensure and the status of AIU and/or MU of their certified EHR technology that is being used in their practice setting.⁴

To register as a Medicare or Medicaid Eligible Professional please click here.

Please note that although the Medicaid EHR Incentive Programs began on January 3, 2011, not all states were ready to participate on that date. Information about registration timelines for state-specific Medicaid EHR incentive Programs will be updated as it becomes available at the following link: http://www.cms.gov/EHRIncentivePrograms/40_MedicaidStateInfo.asp.

For guidance on how to register as a Medicare Eligible Professional (EP) go here.⁵

For specific directions on how to register as a Medicaid Eligible Professional please visit here.⁶

DISCLAIMER: THE INFORMATION CONTAINED IN THIS WEB SITE IS PROVIDED FOR INFORMATIONAL PURPOSES ONLY AND REPRESENTS NO STATEMENT, PROMISE OR GUARANTEE BY JANSSEN DIAGNOSTICS, INC. CONCERNING RECEIPT OR PAYMENT OF GOVERNMENT INCENTIVES. JANSSEN DIAGNOSTICS, INC. STRONGLY URGES THAT YOU CONSULT WITH YOUR COUNSEL FOR ADVICE ON INCENTIVE ELIGIBILITY.

Incentive Payment Overview

Kahn, J; Mills, M; Centers for Medicare & Medicaid Services; Center for Medicaid, CHIP, and Survey and Certification; EHR Incentive Program Final Rule: Medicaid Provisions; July 16, 2010. Slide 41.
Centers for Medicare & Medicaid Services; Medicare and Medicaid EHR Incentive Program Final Rule, Implementing the American Recovery & Reinvestment Act of 2009; July 20, 2010. Slides 42-44.
Kahn, J; Mills, M; Centers for Medicare & Medicaid Services; Center for Medicaid, CHIP, and Survey and Certification; EHR Incentive Program Final Rule: Medicaid Provisions; July 16, 2010. Slide 25.
Kahn, J; Mills, M; Centers for Medicare & Medicaid Services; Center for Medicaid, CHIP, and Survey and Certification; EHR Incentive Program Final Rule: Medicaid Provisions; July 16, 2010. Slide 26.
This is a downloadable step-by-step brochure to guide eligible providers through the registration and submission process for the Medicare program on the CMS website. The PDF is available through the following link. http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRMedicareEP_RegistrationUserGuide.pdf
This is a downloadable step-by-step brochure to guide eligible providers through the registration and submission process for Medicaid programs on the CMS website. The PDF is available through the following link. http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRMedicaidEP_RegistrationUserGuide.pdf

HITECH and Meaningful Use

Differences between the Medicaid and Medicare Plans

Are there differences between the Medicaid and Medicare programs?

Differences between the Medicaid and Medicare Plans

Which program is right for me?

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