Thursday, June 16, 2011

What is an EP?

An EP is an Eligible Professional. Different types of EPs are eligible for the Medicare and Medicaid programs. Unlike eligible hospitals, EPs are not eligible to participate in both the Medicare and Medicaid programs. Below is a listing of the eligible professionals in each program:
Eligible Medicare EPs include:
  • Doctors of Medicine or Osteopathy
  • Doctors of Dental Surgery or Dental Medicine
  • Doctors of Podiatric Medicine
  • Doctors of Optometry
  • Chiropractors
Eligible Medicaid EPs include:
  • Physicians
  • Nurse Practitioners
  • Certified Nurse - Midwife
  • Dentists
  • Physicians Assistants who practice in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) that is led by a Physician Assistant
Medicaid EPs also must have a minimum of 30% Medicaid patient volume (20% minimum for pediatricians) or practice predominantly in a FQHC or RHC and have at least 30% patient volume to needy individuals.
Hospital based providers, defined as a provider who provides 90% or more of their services in either the inpatient or emergency department of a hospital, are not eligible for the Medicaid or Medicare programs.

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