To participate in MPIP, an eligible professional must have an active Ohio Medicaid Provider Agreement; be free from sanctions or exclusions from the Office of the Inspector General (OIG) and the State of Ohio; and meet other program specific requirements. Eligible professionals may receive up to six MPIP incentive payments.
Eligible professional types include:
- Physicians
- Optometrists
- Dentists
- Certified Nurse-Midwives
- Nurse Practitioners
- Physician Assistants (PA) practicing in an FQHC or an RHC that is so led by a PA
Eligible professionals may not be hospital based. An eligible professional is considered hospital based when 90% or more of the eligible professional’s Medicaid encounters are furnished in an inpatient hospital (place of service code (POS) 21) or an emergency room (POS 23) setting in the calendar year prior to the payment year. This exclusion does not apply to eligible professionals that practice predominantly through a Federally Qualified Health Center (FQHC) or a Rural Health Center (RHC).
Patient Volume Requirements
For each year of participation, eligible professionals must meet one of the following patient volume requirements:
- A minimum of 30% Medicaid patient volume.
- A minimum of 20% Medicaid patient volume and be a pediatrician.
- A minimum of 30% needy individual patient volume and practice predominantly through an FQHC/RHC.
The following resources are available to assist eligible professionals calculate their patient volume:
Incentive Payments
Eligible professionals may receive up to $63,750 over the six years that they chose to participate in MPIP. The first year incentive payment amount is $21,250. For subsequent payment years the incentive payment amount is $8,500. For Pediatricians attesting to greater than 20% but less than 30% patient volume the first year incentive payment amount is $14,167. For subsequent payment years, the incentive payment amount is $5,667. The last year to initiate enrollment for payment year one is calendar year (CY) 2016. The last program payment year is 2021.
Incentive payments will be made to the TIN designated during registration at CMS. Eligible professionals may use their own payee information or reassign the payment to an employer or entity that has a contractual agreement with the eligible professional allowing the employer or entity to bill and receive payment for their professionally covered services. An eligible professional will be asked to provide a payee TIN and NPI during registration with CMS.
Appeals
Eligible professionals may request an informal review of a preliminary adverse decision regarding incentive payment amounts, and eligibility requirements. An informal review request can be made through the MPIP system within 15 days of an ineligibility notification.