Are You Eligible for ARRA Money?

Updated 09/03/2010 by Erica Greenwood

There's been a lot of hopeful anticipation about incentive payments for providers looking to implement an electronic health record (EHR), or for compensation for EHRs they've already adopted. Pediatricians are no exception to wanting their share of ARRA funds, but what about those meaningful use requirements, and what, specifically, do pediatricians need to know in order to pursue stimulus funding for their EHR?

PCC has followed this issue from the beginning and will attempt to answer some of these convoluted questions. In a series of articles, we will provide a list of guidelines and requirements to help pediatric practices like yours sort through this information, starting with this one which addresses who is eligible to receive ARRA funding.

Note: There are two incentive options allocated for EHR adoption in the ARRA –Medicare and Medicaid incentives. This article will only focus on the Medicaid incentives because most pediatricians would qualify under this option.

Who is eligible to receive EHR Medicaid incentive funds?

Professionals who are eligible for Medicaid incentives include non-hospital based pediatricians with at least a 20% Medicaid patient volume (or, in the case of eligible professionals practicing predominately at Rural Health Clinics and Federally Qualified Health Centers, the patient volume threshold is 30 percent). Take a look at this excerpt from the Federal Register document that explains Medicaid incentive eligibility. 

One study estimates that there are 14,400 pediatricians who would be eligible to receive stimulus funds, based on their Medicaid patient volume, or about 42% of pediatricians who would qualify under these guidelines. PCC's Pediatric Solutions Team estimates that only about one third of PCC clients qualify for just this initial criteria. Additionally, individual states may have further qualifying criteria, though it has not yet been determined. Read more about this on Chip's Blog.

PCC clients can look at their percentage of Medicaid patient volume, by logging into their Practice Vitals Dashboard and reviewing their Payor Analysis under the Advanced Dashboard menu and adjusting the dates to any 90 day period. Or, clients may contact PCC Support with questions about their Medicaid Payor Mix at (800)-722-1082.

If you have a patient volume of less than 20% Medicaid, you can stop worrying about all of this. Choose the EHR that you like the best and implement it within the timetable that makes the most sense for your practice. If you do meet this initial qualification, you should still choose the EHR you like the best, though this incentive presents other considerations that may help you determine whether or not it makes sense for you to pursue ARRA funding.

How much money is it?

Here are a few basic facts we've compiled that help summarize what we know about the funds:

• Pediatricians with a Medicaid Patient Volume of at least 30% may qualify to receive $21,250 per provider (85% of $25,000 in the first year), and $8,500 per provider (85% of $10,000) for each of 5 subsequent years, up to a total of $63,750 per provider over the six year program. View the pricing table from the Federal Register for pediatricians with at least 30% Medicaid Patient Volume.
• There is a special exception for Pediatricians with a Medicaid Patient Volume less than 30% that helps more pediatricians to qualify. Pediatricians with a Medicaid Patient Volume that is at least 20% and up to 30% may qualify to receive 2/3 of the incentive amount.  Pediatricians meeting this lower threshold may qualify to receive $14,167 per provider in the first year and $5,667 per provider for each of the 5 subsequent years, up to a total of $42,500 per provider over the six year program. View the pricing table from the Federal Register for pediatricians with at least 20% Medicaid Patient Volume.

Qualification for Medicaid incentives is additionally dependent upon use of a "certified" EHR and proof of being a "meaningful" EHR user. We will also post articles in the coming weeks that address the latest developments in the Certification and Meaningful Use discussions that will help inform your decisions. 

For more on this topic read our ARRA Eligibility FAQ and visit http://www.pedsource.com/ehrmoney for the next article in this three part series about Certification