In the HITECH act, primary care providers, including Rural Health Clinics, have two ways to receive funding – through the Medicare incentive payment or the Medicaid incentive payment. To reach the Medicaid incentive payment, RHCs and other practices will need to meet the 30% “Needy” patient threshold which includes all Medicaid, CHP+, and uninsured patients (including sliding fee scale).

Medicare incentives are based on providers reaching a minimum threshold of Medicare charges according to the annual physician fee schedule payment. For RHCs, this means the threshold has to be met out of the annual Part B billing charges since Part A billing is not calculated according to the physician fee schedule. The regulation reads that 75% of allowable charges must equal that year’s incentive payment. For example, the year one incentive payment is $18,000 per eligible provider, so the RHC must have $24,000 in allowable charges for their Medicare Part B payments for that year in order to receive the full $18,000 incentive payment.

We will be further clarifying this issue with CMS and will be discussing the implications of this rule on Colorado’s RHCs on our next Consortium Webinar, Sept. 23, from 12-1:15pm.