Select your role?

Doctor of medicine or osteopathy

Doctor of podiatric medicine

Doctor of optometry

Doctor of dental surgery or medicine

Chiropractor

None of the above

Select your role?

Physician

Dentist

Certified nurse-midwife

Nurse practitioner

Physician assistant

None of the above

You can not get paid from both programs at the same time. In order to choose which program to get paid from, use this form by selecting 'Medicare' first, completing the form, seeing your maximum payment amount and then selecting 'Medicaid' and completing that form. Based on the results shown when having completed the forms, you will know which program to apply to; the one that will pay you the most, of course. Note, that within the incentive payment period you will be able to switch from one program to the other if changes in your patient population make it more lucrative to do so. However, you can only make a switch one time.

In how many non-hospital locations do you practice? One    More than one

Are you currently using an EMR? Yes    No

Are you currently using an EMR at the location(s) where you spend at least 50% of your time? Yes    No

Do you practice in a Health Provider Shortage Area (HPSA)? How do I know? Yes   No

How much do you submit in Medicare claims per year? $ .00

Do 90% or more of your Medicare claims include one of these Place Of Service (POS) codes? 21 (Inpatient Hospital), 22 (Outpatient Hospital), 23 (Emergency Room - Hospital) Yes   No

Do you practice more than 50% of the time at a Federally Qualified Health Center (FQHC) or Regional Health Center (RHC)? How do I know? Yes   No

Do 30% of your patients qualify for the following conditions? Yes   No Receive medical assistance from Medicaid or the CHIP. Receive care by the provider for which they are uncompensated. Includes bad debt. Receive services furnished at either no cost or reduced cost based on a sliding scale determined by the individual's ability to pay.

Are you a pediatrician? Yes   No

Do you see Medicaid patients from more than one state? Yes   No

Are % of your patients covered by Medicaid? Yes   No

For any state where your patients reside, are % of your patients, from at least one of those states, covered by Medicaid from thier state of residence? Yes   No

In how many non-hospital locations do you see Medicaid patients? One    More than one

Are you currently using an EMR? Yes    No

Are you currently using an EMR at the location(s) where you spend at least 50% of your time and where you see your Medicaid patients? Yes    No

If a portion of your EMR has been paid for by an organization, enter the amount that has been paid: Example Organizations: Hospital, Physician Organization, Laboratory Not getting external funding External funding for EMR purchase: $.00 External funding, or anticipated funding amount, for annual EMR maintenance: $.00

If you expect a portion of your EMR to be paid for by an organization, enter the amount that you expect will be paid: Example Organizations: Hospital, Physician Organization, Laboratory Not getting external funding Expected external funding for EMR purchase: $.00 Expected external funding for annual EMR maintenance: $.00

Unfortunately, you DO NOT qualify for stimulus bill incentives under the HITECH Act of the ARRA law.

Congratulations! You can qualify for a Stimulus Bill Incentive of up to the following amounts: Year 1:  $  Year 2:  $  Year 3:  $  Year 4:  $  Year 5:  $  Total :  $  Now you know how much you can expect to be paid in Stimulus payment. However, there are further stipulations that you must meet in order to recieve those payments. Read the Frequently Asked Questions (FAQ) section below to learn what you need to do in order to recieve your payments.

Congratulations! You can qualify for Stimulus Bill Incentive Payments of up to the following amounts: Year 1:  $  Year 2:  $  Year 3:  $  Year 4:  $  Year 5:  $  Year 6:  $  Total :  $  Now you know how much you can expect to be paid from the Stimulus Bill. However, there are further stipulations that you must meet in order to recieve these payments. Read the Frequently Asked Questions (FAQ) section below to learn what you need to do in order to recieve your payments.