Program Eligibility

CMS has created an interactive tool to assist health care providers with determining their eligibility for participation in the EHR Meaningful Use programs. Visit the CMS EHR Incentives Program page and download the “EHR EP Decision Tool,” near the bottom of the page under “Downloads.”

The Doctor of Dental Surgery (DDS) and Doctor of Dental Medicine (DMD) are Medicare eligible providers.

Eligible Doctors of Dental Surgery or Dental Medicine in Medicare Advantage (MA) must furnish at least 80 percent of their Medicare-related professional services to enrollees of the MA organization and must furnish, on average, at least 20 hours/week of patient-care services. In addition, MA eligible providers must either(1) be employed by the qualifying MA organization or (2) must be employed by, or be a partner of, an entity that through contract with the qualifying MA organization furnishes at least 80 percent of the entity’s Medicare patient care services to enrollees of the qualifying MA organization.

In Medicaid, eligible providers include, among others, the Doctor of Dental Surgery (DDS) and Doctor of Dental Medicine (DMD). An eligible DDS or DMD must have at least a 30% patient volume attributable to Medicaid.

Eligible Doctor of Dental Surgery (DDS) and Doctor of Dental Medicine (DMD) may meet the 30% volume requirement either from a group calculation or individual calculation. Each state must select a method of calculating patient volume and that dentists should contact their State Medicaid Agencies for more information on how their states are calculating patient volume.

Eligible professionals may participate in the Medicaid EHR Incentive Program if: 1) They meet Medicaid patient volume thresholds; or 2) They practice predominantly in an FQHC or Rural Health Clinic (RHC) and have 30% needy individual patient volume. Needy individual encounters are those encounters funded in part or in whole by State Medicaid programs, uncompensated care, or patient payment based on a sliding scale. Please contact your State Medicaid agency for more information on which types of encounters qualify as Medicaid/needy individual patient volume.

No. Hospital-based Doctors of Dental Surgery (DDS) and Doctors of Dental Medicine (DMD) do not qualify for the EHR incentive program. Hospital-based dentists are defined as those furnishing 90% or more of their professional services in either inpatient or emergency department of a hospital. Dentists who practice in hospital-owned outpatient clinics qualify for the incentive program, provided they meet all other program criteria.

If dentist uses a certified EHR in a meaningful way (meeting applicable CMS requirements), could that dentist receive both the Medicare EHR payment incentive as well as the Medicaid EHR payment incentive?
No. An eligible professional may only receive an EHR payment under either Medicare or Medicaid.

Yes. The funding is available per eligible dentist.

The Centers for Medicare and Medicaid Services plays a central role in administering both incentives. Regardless of whether a dentist chooses Medicare or Medicaid incentives, he or she will be required to enroll through the CMS official website for the incentive programs.

Once the information is entered, the dentist will select either the Medicare or Medicaid incentive program. If a dentist chooses the Medicaid incentives, additional information must be given to the dentist’s State Medicaid Incentive Program. This process will happen via the state’s Medicaid Incentive Program website.

Contact EHR

American Dental Association
Department of Dental Informatics
Phone: 312.440.2500
Email: EHR@ada.org
ADA business hours are 8 a.m. to 5 p.m. U.S. Central Time.