Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

Avoiding EHR Incentive Program Payment Adjustments

Hardship Exemptions Now Being Accepted; Some Specialties Need Not Apply

Medicare eligible professionals (EPs) who do not attest to meaningful use of a certified electronic health record (CEHRT) under the Medicare or Medicaid EHR Incentive Programs will begin receiving payment penalties with January 1, 2015, dates of service. To avoid the penalty, professionals should have attested to meaningful use in 2013, can attest to meaningful use by October 1, 2014, or if eligible, should file a hardship exemption by July 1, 2014.

The payment adjustment is 1% per year and is cumulative for every year that an eligible professional is not a meaningful user. The amount of future years’ penalties also depend on the overall EHR meaningful use among all physicians, however, and if fewer than 75% are meaningful users in 2018, the penalty can go up to as much as 5%. Otherwise, it will be capped at 3%.

Hardship exemptions are available to eligible providers who fall within the following categories:

  • Infrastructure: Eligible professionals who practice in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure.
  • New Eligible Professionals: Newly practicing eligible professionals who would not have had time to become meaningful users can apply for a two-year limited exception to payment adjustments.
  • Unforeseen Circumstances: Examples may include a natural disaster or other unforeseeable barrier.
  • Patient Interaction: Including a lack of face-to-face or telemedicine interaction with patient or a lack of follow-up need with patients.
  • Practice at Multiple Locations: Lack of control over availability of CEHRT for more than 50% of patient encounters.
  • 2014 EHR Vendor Issues: The eligible professional’s EHR vendor was unable to obtain 2014 certification or the eligible professional was unable to implement meaningful use due to 2014 EHR certification delays.

If an eligible provider falls within one of these categories, he should submit a hardship application by July 1, 2014. The hardship exemption application is available to download at the CMS (Centers for Medicare and Medicaid Services) EHR Incentive Programs webpage.

Some providers are either not eligible for the program or are eligible but automatically exempt from the program. These providers do not have to file for a hardship exemption and will not be subject to the payment adjustment:

  • Specialties – If you are classified in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) as having one of the following 5 specialty codes below as your primary area of practice you do not need to submit this form. You will be granted a Hardship Exception and are automatically exempt from the 2015 payment adjustment based on the data in PECOS. If you have multiple specialties and are not certain which one is listed as primary, you should check the PECOS system to confirm your status: Diagnostic Radiology (30), Nuclear Medicine (36), Interventional, Radiology (94), Anesthesiology(05), or Pathology (22).
  • Hospital-Based EPs – If you are a hospital-based EP for 2012 or 2013, you DO NOT need to submit this form. “Hospital-based” is defined as performing 90% or more of your covered professional services in either the inpatient (Place of Service 21) or emergency department (Place of Service 23) of a hospital. If this is the case of your practice, you will be granted a Hardship Exception and are automatically exempt from the 2015 payment adjustment based on the data in PECOS.

For more information, review the CMS EHR Incentive Program Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals.

Physicians wishing to attest to Meaningful Use in 2014 also will be interested in the May 20 announcement by CMS regarding the use of a 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT for the EHR reporting period in 2014 for the Medicare and Medicaid EHR Incentive Programs.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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