Editor’s Note: Subsequent to the publication of this article, CMS has renamed the “Meaningful Use” programs and MIPS “Advancing Care Information” category to “Promoting Interoperability”.
The Meaningful Use program uses the terms “Eligible Professional” and “Eligible Hospital” to designate those individuals and institutions who may choose to participate, may receive incentives, or may receive payment adjustments for non-participation.
Mid-level Practitioners like Nurse Practitioners (NPs) and Physician Assistants (PAs), among others, are generally not eligible to participate or receive incentives, and are never subject to payment adjustments (reductions in payments or penalties).
Under the Medicare program, mid-level practitioners are excluded, as participation is limited to:
- Doctors of medicine or osteopathy
- Doctors of dental surgery or dental medicine
- Doctors of podiatry
- Doctors of optometry
- Chiropractors
The Medicaid program, however, includes some mid-level practitioners among those eligible to participate:
- Physicians (primarily doctors of medicine and doctors of osteopathy)
- Nurse practitioner
- Certified nurse-midwife
- Dentist
- Physician assistant who furnishes services in a Federally Qualified Health Care Center or Rural Health Clinic that is led by a physician assistant
This means that if a mid-level practitioner successfully participates in the Medicaid Meaningful Use Incentive Program, they may receive incentive payments. However, participation under the Medicaid program requires a Medicaid patient volume of at least 30% (or a 30% volume of “needy individuals” for those practicing in an RHC or FQHC), or 20% for pediatricians. This makes many mid-level practitioners ineligible for either program.
Payment adjustments, on the other hand, are only applied to “Medicare eligible professionals, eligible hospitals, and critical access hospitals (CAHs) that are not meaningful users of Certified Electronic Health Record (EHR) Technology under the Medicare EHR Incentive Program…Medicaid providers who are only eligible to participate in the Medicaid EHR Incentive Program are not subject to these payment adjustments.”
(emphasis added; source: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/PaymentAdj_Hardship.html)
Since mid-level practitioners are not considered Medicare eligible professionals, they are not subject to payment adjustments if they are not meaningful users, and there are no payment adjustments for those who are only eligible for the Medicaid program.
