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EHR Incentive Updates & Changes

Beginning Jan. 1, 2013, there were several minor changes to the EHR Incentive Payment Program for specific measures, the most significant of which is how a Medicaid encounter is defined.

A Medicaid encounter means services rendered to an individual on any one day where:

  • The individual was enrolled in a Medicaid program (or a Medicaid demonstration project approved under section 1115 of the Act) at the time the billable service was provided without  a requirement of Medicaid payment liability

This change in the Medicaid patient volume calculation is applicable to all eligible providers, regardless of the stage of the Medicaid EHR Incentive Program they are participating in. Billable services provided by an eligible provider to a patient enrolled in Medicaid would count toward meeting the minimum Medicaid patient volume thresholds.

Examples of Medicaid encounters under this expanded definition that could be newly eligible might include: behavioral health services, HIV/AIDS treatment, or other services that might not be billed to Medicaid/managed care for privacy reasons, but where the provider has a mechanism to verify eligibility. Also, services to a Medicaid-enrolled patient that might not have been reimbursed by Medicaid (zero-paid claims) may now be included in the Medicaid patient volume calculations.

For more information regarding CMS Stage 2 Rule changes providers can visit the Department of Health and Social Services public website.