One key aspect of eligibility is patient volume. To qualify for an incentive payment under the Illinois EHR Medicaid Incentive Payment Program, an eligible professional must meet one of the following criteria for Medicaid patient volume:

  • Have a minimum 30% Medicaid patient volume
  • Have a minimum 20% Medicaid patient volume, and be a pediatrician

Clinics or group practices will be permitted to calculate patient volume at the group practice/clinic level only in accordance with all of the following limitations:

  • The clinic or group practice's patient volume is appropriate as a patient volume methodology calculation for the EP
  • There is an auditable data source to support the clinic's or group practice's patient volume determination
  • All EPs in the group practice or clinic must use the same methodology for the payment year
  • The clinic or group practice uses the entire practice or clinic's patient volume and does not limit patient volume in any way
  • If an EP works inside and outside of the clinic or practice, then the patient volume calculation includes only those encounters associated with the clinic or group practice, and not the EP's outside encounters.

If you have not submitted your patient volume for pre-approval for 2020 you can still do so. HFS is currently accepting pre-approval requests for 2021. We encourage you to send your patient volume pre-approval request sooner than later.

If you do submit your patient volume and it gets rejected it does not mean you cannot attest. It just means that there is a discrepancy between what your data and the state’s data. Often it has to do with the way the practice’s reports are run. Please contact ILHITREC if your patient volume gets rejected and we can help you look at your reports and find the issue.

 

Patient Volume Pre-Approval Process
Contact HFS at hfs.ehrincentive@Illinois.gov
Provide the following information:

     TIN =

     Group or individual numbers?

     Provider type:  (physician, hospital, dentist)

     Date Range (90 day period in previous year to reporting year) =

     Straight Medicaid (only traditional Medicaid & All Kids) =

        (count ALL encounters where straight Medicaid is the primary, secondary, or tertiary coverage
        even if Medicaid paid $0.00 and Medicaid/Medicare crossovers)

     Medicaid Managed Care =

     Total Encounters for all payees =

Resources

Promoting Interoperability Program Eligibility