In order to qualify for incentives under the New Jersey Medicaid EHR Incentive Program, providers must meet both a Medicaid provider type requirement and a Medicaid patient volume requirement. Additionally, the Medicaid provider cannot be “hospital based”, defined as 90% or more of the provider's encounters taking place at an inpatient or emergency room place of service/practice location.
Physicians/clinicians cannot participate in both the Medicare and Medicaid EHR Incentive Programs. For more information on the differences between the Medicare and Medicaid EHR Incentive Programs, click on this link: Medicaid vs. Medicare?
Only the specific types of Medicaid physicians/clinicians listed below are eligible to receive New Jersey Medicaid EHR Incentive Program payments.
Eligible professionals that are not pediatricians must establish a 30% minimum Medicaid (Title XIX fee-for-service and managed care only) patient volume over any 90 day period in the most recently completed calendar year to be eligible for a New Jersey Medicaid EHR Incentive Program payment. Any attestations submitted for a calendar year 2012 EHR Incentive Program payment (available through March 31, 2013) should use patient volume from a 90 day period in calendar year 2011; attestations submitted for calendar year 2013 EHR Incentive Program payments (available starting April 1, 2013) should use patient volume from a 90 day period in calendar year 2012.
Pediatricians will need to establish a 20% Medicaid patient volume over any 90 day period in the most recently completed calendar year to be eligible for a 2/3 incentive payment. Pediatricians that establish a 30% Medicaid patient volume will receive a full incentive payment.
The only exception to the Medicaid patient volume is if a provider practices predominantly in a Federally Qualified Health Center (FQHC), defined at 50% or more a provider's total encounters over a six month period in the most recently completed calendar year having taken place in an FQHC. If this "practicing predominantly" condition is met, the provider can then show that 30% of their encounters were provided to "Needy Individuals", which include the following:
- Medicaid or CHIP clients;
- Patients furnished uncompensated care by the provider; or
- Furnished services at either no cost or on a sliding scale.
Additional information on New Jersey Medicaid EHR Incentive Program patient volume calculations can be found here.
The following table summarizes patient volume requirements for each New Jersey eligible provider type during the first year of the Medicaid EHR Incentive Program.