Applying for a Meaningful Use Hardship Exception
By Joy Rios, Partner at Practice Transformation
Twitter: @askjoyrios
What is the Meaningful Use Hardship Exception?
Penalties for the Medicare EHR Incentive Program are set to begin January 1, 2015 in the form of a 1 percent negative payment adjustment on Medicare Part B reimbursements. The penalty will increase by 1 percent each year, capping at 5 percent in 2019. Remember that there are no penalties under the Medicaid EHR Incentive Program, and Medicaid eligible professionals (EPs) who can only participate in the Medicaid EHR Incentive Program and do not bill Medicare are not subject to these payment adjustments.
However, some Medicare EPs may be eligible to delay the penalty for a year. Is that you?
Who should apply for the Hardship Exception?
- Returning EPs who did not successfully attest MU in 2013. (Eg. You successfully attested in 2011 or 2012, but did not successfully attest in 2013)
- EPs who have not participated in MU to date, but plan to attest before Oct. 1, 2014
Who does not need to apply?
- EPs who successfully attested MU in 2013. You are already exempt from the 2015 payment adjustment.
- If your primary area of practice is classified in the PECOS system by July 1, 2014 as any of these Specialties:
- Diagnostic Radiology (30)
- Nuclear Medicine (36)
- Interventional Radiology (94)
- Anesthesiology (05)
- Pathology (22)
- Newly practicing EPs who enrolled in Medicare in 2013 or 2014
- EPs who were Hospital-based for 2012 or 2013
What circumstances qualify as hardship?
- Infrastructure: if you are in an area without sufficient internet access
- Unforeseen Circumstances: natural disaster or other unforeseeable barrier
- Patient Interaction: Lack of face-to-face or telemedicine interaction with patients, or lack of follow-up need with patients
- Multiple Locations: Lack of control over availability of certified EHR technology for more than 50 percent of patient encounters
- 2014 EHR Vendor Issues: If the EHR vendor was unable to obtain 2014 certification or if the EP was unable to implement MU due to 2014 EHR certification delays
- Newly Practicing EPs: Newly practicing eligible professionals who would not have had time to become meaningful users are granted two-year limited exception to payment adjustments. No application is required, as CMS will use Medicare claims and enrollment data to determine whether an EP is “newly practicing.” This exception will extend for two years after an EP begins practicing. It is limited in scope, and no extensions beyond the two years are anticipated to be available.
More information can be found on this CMS Hardship Exception tipsheet.
When is the deadline to submit the application?
July 1, 2014
How do EPs request an exception?
Fill out this application and email it, along with your supporting documentation, to ehrhardship@provider-resources.com. For EPs without access to email, send the application and supporting documentation via fax to 814-464-0147. Make sure to keep a copy for your records.
Supporting documentation can be in PDF, Word, or Excel documents.
How long is the exception valid?
If granted, the hardship exception is valid for 1 payment year only. EPs must qualify for most hardship exceptions on a year-to-year basis, and in no cases will an exception be granted for more than five years.
Note that determinations by CMS are final and cannot be appealed.
What about the proposed rule?
The proposed rule may offer some flexibility for EPs who have experienced EHR vendor issues. If it is passed, EPs whose EHR vendor was delayed in or unable to certify to the 2014 standards will be able to demonstrate to the level of their EHR. See below:
However, it is important to consider timing. The hardship exception deadline is July 1. The proposed rule will not be made final until July 21 at the soonest. If you qualify for the hardship exception under the 2014 EHR Vendor Issues category, it would be prudent to submit the hardship exception application to hedge the bet that the proposed rule is not finalized.
Which, by the way, comments are open. If you have an opinion about the proposed rule, you may submit your comments by following these directions.
Want more practical Meaningful Use information?
I’ll be presenting a thorough overview of Meaningful Use through a 4-day online, live workshop June 18,19, 25, and 26. Spend just one hour each day to get a better understanding of MU and become a Certified Meaningful Use Professional. Go here to register and save $100 off retail price.
- Session 1: MU Overview & Basics
- Session 2: MU Objectives & CQM Deep Dive
- Session 3: Action Plan for Tracking & Monitoring Progress
- Session 4: How to Attest & What to Expect During the Process
This article was originally published on Practice Transformation and is republished here with permission.