ARRA Eligible Providers: Who Is Eligible to Receive Stimulus Money and How Much is Available Per Provider?


Note: read my latest post on getting the EHR Incentives here.

Medicare Definition of Eligible Provider (EP)

For Medicare, physicians and some hospitals are eligible providers. “Physicians” includes doctors of medicine (MD) or osteopathy (DO), dentists or dental surgeons (DDS or DMD), podiatric medicine (DPM), and optometry (OD) and chiropractors (DC).

For providers, their annual payment will be equal to 75 percent of Medicare allowable charges for covered services in a year, not to exceed the incentives in the table below.  Payments will be made as additions to claims payments.

Hospitals include quick-care hospitals (subsection-d) and critical access hospitals  and only includes hospitals in the 50 States or the District of Columbia.

Medicaid Definition of Eligible Provider (EP)

Medicaid takes the Medicare definition of eligible providers (physicians) and adds nurse practitioners, certified nurse midwives and physician assistants, however, physician assistants are only eligible when they are employed at a federally qualified health center (FQHC) or rural health clinic (RHC) that is led by a Physician Assistant.  Eligible hospitals include quick care hospitals and children’s hospitals.

At minimum, 30 percent of an EP’s patient encounters must be attributable to Medicaid over any continuous 90-day period within the most recent calendar year. For pediatricians, however, this threshold is lowered to 20 percent.

The first year of payment the Medicaid provider must demonstrate that he is engaged in efforts to adopt, implement, or upgrade certified EHR technology.  For years of payment after year 1, the Medicaid provider must demonstrate meaningful use of certified EHR technology.

Change 1:

The  definition of “hospital-based physician” was recently clarified to include physicians working in hospital outpatient clinics (employed physicians) as opposed to the inpatient units, surgery suites or emergency departments.  This still excludes pathologists, anesthesiologists, ER physicians, hospitalists and others who see most of their patients in the ER as outpatients or as hospital inpatients.

Possible Change 2:

The Health Information Technology Extension for Behavioral Health Services Act of 2010 (HR 5040)  is a bill in the US Congress originating in the House of Representatives that would amend the Public Health Service Act and the Social Security Act to extend health information technology assistance eligibility to behavioral health, mental health, and substance abuse professionals and facilities, and for other purposes.  You can track the bill here.

For more information on stimulus money for meaningful use of an EMR, read my post here.

Posted in: Electronic Medical Records, Headlines, Medicare & Reimbursement

Leave a Comment (7) ↓


  1. Grant Phelps September 7, 2010

    Are Hospice organizations eligable for any of the AR&RA funding if they are proceeding with EHR / EMR systems?
    Many thanks!

    • Mary Pat Whaley September 7, 2010

      Hi Grant,

      I found this information in the literature review:

      “The Act expands the definition of “health care provider” from the original bill, to include a community mental health center, renal
      dialysis facility, blood center, ambulatory surgical center, emergency medical services provider, and a therapist. The complete list
      includes, in addition to these, a hospital, skilled nursing facility, home health entity or other long term care facility, health care clinic,
      Federally qualified health center, group practice, a pharmacist, laboratory, physician, practitioner, provider operated by, or under
      contract with, the Indian Health Service or by an Indian Tribe, tribal organization, a rural health clinic, among others.”

      So, to answer your question, it does not sound as if hospice organizations themselves will qualify, however providers in hospice care will, depending on their use of an EMR. You can also check this link which has other good information on payment reform for hospice care.

      Best wishes,

      Mary Pat

  2. Donnelle Wagner July 18, 2012

    Is there a reason that the Nurse Practitioner is recognized for reimbursement with Medicaid, but not with Medicare?

    • Mary Pat Whaley July 18, 2012

      Hi Donelle,

      Great question! I’ve never seen an explanation of the reasoning behind this, but my opinion is that so many providers have opted out of providing care to Medicaid that the program was extended to Nurse Practitioners.

      Best wishes,

      Mary Pat