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Medicaid Promoting Interoperability Program

Formerly known as the EHR Incentive Program

About the Program

The Health Information Technology for Economic and Clinical Health Act established programs for Medicare and Medicaid to provide incentive payments for the PI Program of Certified EHR Technology. The first part of the program focuses on adopting, implementing, or upgrading Certified Electronic Health Record (EHR) Technology.* The subsequent additional incentive payments focus on utilizing the certified EHR technology in a meaningful way.

For more information Click here.

NJII offers free assistance to Medicaid-participating providers in the Medicaid Provider Program (MPP) to help them achieve HIE milestones for the PI Program in fulfilling certain Transitions of Care objectives.

If you would like our assistance with the PI Program, email us at mu@njii.com and click here for our Participation Agreement.

*Note: The last year to begin participating in the Medicaid PI Program was 2016. (Previously known as the EHR Incentive Program)

Payment

The Medicaid patient-volume calculation method is designated by the State Medicaid Agency and is approved by CMS. In general, patient volume is calculated by dividing the provider’s encounters with Medicaid-enrolled patients by the provider’s total number of service encounters.

Pediatricians who meet the 30% patient-volume requirement may qualify to receive the maximum incentive payments. Incentive payments for pediatricians who meet the 20 percent Medicaid patient volume, but fall short of the 30% Medicaid patient volume, are reduced to two-thirds of the incentive payment. This means some pediatricians may receive $14,167 in the first year and $5,667 in subsequent years.

If New Jersey Medicaid can establish that the patient volume and certified EHR technology eligibility requirements are met, the eligible professional will receive New Jersey Medicaid PI Program payments. For payment Schedule click here.

Primary-care providers can earn up to $63,750 in incentive funding. The last year to begin participating in the Medicaid PI Program was 2016.

Patient-Volume Calculation

The New Jersey Medicaid EHR Incentive Program defines a patient encounter as a distinct patient, date-of-service, and place-of-service combination.

A Medicaid patient encounter is any patient encounter (as defined above) rendered to an individual enrolled in a Medicaid fee-for-service or managed care program, regardless of whether the provider was paid by Medicaid for the encounter. Note that this definition excludes certain categories of NJ FamilyCare children and adults that are enrolled in a Title XXI Children’s Health Insurance Plan (CHIP) program For more information on calculating patient encounter volume  click here.

Timeframe

The last year to begin participating in the Medicaid Promoting Interoperability Program was 2016. Eligible Professionals may receive Medicaid Promoting Interoperability payments for up to six years; 2021 is the final year for Medicaid Promoting Interoperability payments.

For more information, email us at mu@njii.com or visit the Medicaid State Information page here.

New Jersey Innovation Institute
NJIT 400 Fenster Hall
323 Dr Martin Luther King Jr Blvd
Newark, NJ 07102

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mu@njii.com
973-642-4055, Option 2