Q. Are only physicians allowed to participate in the Medicare incentive plan?
A. For the Medicaid program, eligible professionals are physicians, dentists, certified nurse midwives, nurse practitioners, and physician assistants who are practicing in federally qualified health centers (FQHCs) or rural health clinics (RHCs) led by a physician assistant. For the Medicare program, eligible professionals are doctors of medicine or osteopathy, doctors of dental surgery or medicine, doctors of podiatric medicine, doctors of optometry and doctors of chiropractic medicine. Physical therapists are not considered.

Q. What happens if we begin the process of switching to EHR and a new associate joins our practice? Can they start participating in the incentive program at that point or do they need to start the process from the beginning?
A. Eligible professionals can be added during the program.

Q. Are there any restrictions to hospital-owned physician/provider practices?
A. The statute (the HITECH Act, part of the ARRA which was signed into law in Feb. 2009) excludes hospital-based physicians from being eligible for incentive payments. Hospital ownership of a practice is irrelevant with regard to this exclusion. HITECH prohibits EHR incentives to "hospital-based eligible professionals," which it defines as any "eligible professional, such as a pathologist, anesthesiologist, or emergency physician, who furnishes substantially all of such services in a hospital setting (whether inpatient or outpatient) and through the use of the facilities and equipment, including qualified electronic health records, of the hospital. The determination of whether an eligible professional is a hospital based eligible professional shall be made on the basis of the site of service (as defined by the Secretary) and without regard to any employment or billing arrangement between the eligible professional and any other provider." Through its Notice of Proposed Rulemaking published in the Federal Register on January 13, 2010, CMS is proposing to define "hospital based eligible professionals" as those who provide "substantially all" of their services in a hospital setting as those who furnish at least 90% of services in an inpatient or outpatient setting as determined by a set of place of service (POS) codes. Specifically, all services paid under claims with POS codes 21 (inpatient hospital), 22 (outpatient hospital) and 23 (emergency room hospital) would be considered services furnished in an inpatient or outpatient hospital setting. Therefore, services provided in a provider-based outpatient department would count toward the 90 percent threshold. Employment status of the physician is irrelevant with regard to this issue and definition. While, in some areas of the country, it is common for physicians practicing in hospital-based outpatient clinics to be employed by the hospital, employed physicians who practice at in different settings (such as offices or freestanding outpatient clinics) or provide less than 90% of their services in a hospital-based site of service would be able to qualify for incentive payments.

Q. We are a practice of 8 eligible providers. I have a few providers who will not participate. Are those providers who do wish to participate still eligible for payment?
A. Yes, they are still eligible.

Q. If we have more than one doctor in our group, can we apply for both Medicare and Medicaid using each Doctor? I am a billing service and I bill for a psychiatrist and psychologists.
A. A billing service is not eligible for incentive funds. Eligible professional incentives are paid on an individual basis so yes, providers in the same practice can participate in different incentive programs.

Q. I have some confusion regarding the "Eligible Provider" and definition regarding "hospital based". I have surgeons who bill their surgeries with a facility code of the hospitals and not their office. What do you know about this?
A. Professionals, including surgeons, who bill based on POS Codes 21 (inpatient, hospital), 22 (outpatient hospital), or 23 (emergency department, hospital) will not be eligible for incentive payments.

Q. If one physician in a group of five is not using EHR, will only that physician get the reduction in reimbursment in 2015?
A. Yes, that is correct.

Q. Eligible professionals through the Medicare program according to your white paper are limited to physicians. Are mid level providers only eligible through the Medicaid program?
A. Yes, that is correct - mid-level providers are only eligible through the Medicaid program.