Skip to site content

Indian Health Service The Federal Health Program for American Indians and Alaska Natives

Share This Page:

Patient Volume - General

To participate in the EHR Medicaid Incentive Program, all EPs (other than pediatricians) must meet a threshold of 30 percent Medicaid patient volume. Pediatricians must have a minimum threshold of 20 percent Medicaid patient volume. Note that pediatricians who meet this minimum (20 percent) will receive only two-thirds of the Medicaid Incentive payment. Pediatricians who achieve a Medicaid threshold of at least 30 percent will receive the full incentive payment.

EHs are also invited to participate in the EHR Medicaid Incentive Program and must meet a threshold of 10 percent Medicaid patient volume.

Although these thresholds have remained consistent since the program's inception, the calculations for meeting these thresholds have been updated for 2013 to include unpaid claims.

When calculating patient volume for the Medicaid EHR Incentive Program, it is important to understand the difference between the participation year and the qualification year.

  • The participation year for EPs is based on the calendar year. For EHs, it is based on the federal fiscal year for which payment is applied.
  • The qualification year for EPs is the calendar year immediately preceding the participation year. For EHs, the qualification year is the federal fiscal year immediately preceding the participation year.

Learn how to calculate patient volume for the 2011 - 2012 reporting period and for the 2013 reporting period and beyond.