Eligible Hospitals - Incentive Payments

Hospital incentive payments are based on a formula provided in statute that uses a variety of data points. During the first year of participation in the Medicaid EHR Incentive Program, the Wisconsin Medicaid Agency calculates the aggregate EHR incentive payment for Eligible Hospitals; this is the amount they will receive over the life of the program.

The last year for an Eligible Hospital to begin to receive payment is Program Year 2016. In addition, after Program Year 2016, Eligible Hospitals must participate in consecutive years.

The Wisconsin Medicaid Agency will distribute payments over three years according to the following percentages:

  • Payment Year 1: 50 percent of aggregate EHR hospital incentive amount
  • Payment Year 2: 40 percent of aggregate EHR hospital incentive amount
  • Payment Year 3: 10 percent of aggregate EHR hospital incentive amount

Hospital Payment Calculation

Data Needed for Payment Calculation

Eligible Hospitals are required to attach and upload all relevant Medicare cost report sections when submitting their Wisconsin Medicaid EHR Incentive Program application. These report sections will be used to determine the incentive payment amount. Below are the data points needed:

Data Point Needed

If you have the CMS-2552-10 (NEW) cost report form, attach:

If you have the CMS-2552-96 (OLD) cost report form, attach:

Total discharges (four years of data)

Worksheet S-3, Part 1, Column 15, line 14

Worksheet S-3, Part 1, Column 15, line 12

Total Medicaid inpatient bed days

Distributed by the Medicaid EHR Incentive Program "from" email address dhsehrincentiveprogram@wisconsin.gov

Distributed by the Medicaid EHR Incentive Program "from" email address dhsehrincentiveprogram@wisconsin.gov

Total inpatient bed days

Worksheet S-3, Part 1, Column 8, sum of lines 1 and 8-12

Worksheet S-3, Part 1, Column 6, sum of lines 1 and 6-10

Total charges – all discharges

Worksheet C, Part 1, Column 8, line 200

Worksheet C, Part 1, Column 8, line 101

Total charges charity care

Worksheet S-10, column 3, line 20

Worksheet S-10, Line 30

For further explanation of the cost report data needed, refer to the Eligible Hospitals FAQ (PDF, 584 KB).

For a detailed explanation of the formula used to calculate the payment amount, refer to CMS's Tip Sheet - Medicaid Hospital Incentive Payments Calculations (exit DHS) or refer to Appendix B: Hospital Payment Calculation Methodology of the State Medicaid Health Information Technology Plan.

Time Period for Medicare Cost Report Data

Returning Hospital Participants

The time period the data comes from is based upon on the first year the Eligible Hospital participates in the Medicaid EHR Incentive Program, as well as the fiscal year used by the hospital. Eligible Hospitals that received a Wisconsin Medicaid EHR Incentive Program payment in Program Year 2011, 2012, 2013, or 2014 cannot change the Medicare cost report data time period and must submit the Medicare cost reports detailed in the previous section for the fiscal years displayed in the application's Hospital Cost Report Data section.

New Hospital Participants

Eligible Hospitals that begin participation in Program Year 2015 or later are required to use the most recent continuous 12-month period for which Medicare cost report data is available prior to the Payment Year. Please see the table below for the time period you should use for first year applications started in Payment Years 2015 and 2016.

Hospital Fiscal Year Start

Program Year 2015

Program Year 2016

January

January 1, 2013, through December 31, 2013

January 1, 2014, through December 31, 2014

February

February 1, 2013, through January 31, 2014

February 1, 2014, through January 31, 2015

March

March 1, 2013, through February 28, 2014

March 1, 2014, through February 28, 2015

April

April 1, 2013, through March 31, 2014

April 1, 2014, through March 31, 2015

May

May 1, 2013, through April 30, 2014

May 1, 2014, through April 30, 2015

June

June 1, 2013, through May 31, 2014

June 1, 2014, through May 31, 2015

July

July 1, 2013, through June 30, 2014

July 1, 2014, through June 30, 2015

August

August 1, 2013, through July 31, 2014

August 1, 2014, through July 31, 2015

September

September 1, 2013, through August 31, 2014

September 1, 2014, through August 31, 2015

October

October 1, 2013, through September 30, 2014

October 1, 2014, through September 30, 2015

November

November 1, 2013, through October 31, 2014

November 1, 2014, through October 31, 2015

December

December 1, 2013, through November 30, 2014

December 1, 2014, through November 30, 2015
Last Revised: April 28, 2016