CMS Releases Details on Meaningful Use Hardship Exceptions

Ken Terry

January 22, 2016

The Centers for Medicare & Medicaid Services (CMS) today supplied details about the changes in meaningful use hardship exceptions required under the Patient Access and Medicare Protection Act (PAMPA). Enacted December 28, 2015, this law requires CMS to make it easier for physicians and hospitals to request hardship exceptions from the payment adjustments to their Medicare reimbursement in 2017.

CMS did not release its final rule on stage 2 meaningful use changes, including a switch from a 12-month to a 90-day reporting period, until early October. As a result, providers had less than 90 days before year's end to meet the new requirements, although the new rules specified a 90-day reporting period in 2015. In addition, the CMS final rule included changes in electronic health record certification criteria.

There is now a blanket exception for providers who were not able to attest because of the late announcement of these rule changes, according to CMS spokesman Jibril Boykin. To obtain such an exception, he said, eligible professionals should check off box 2.2.d (electronic health record certification/vendor issues) on the application.

The other categories in the application include:

  • insufficient Internet connectivity;

  • extreme and uncontrollable circumstances, including disasters, practice or hospital closures, and severe financial distress;

  • electronic health record certification/vendor issues and lack of control over the availability of certified electronic health record technology; and

  • lack of face-to-face patient interaction.

Under PAMPA, CMS must consider hardship exceptions for "categories" of eligible professionals (EPs) and hospitals on a new, more streamlined basis. Previously, the agency handled requests for hardship exceptions on a case-by-case basis.

In the instructions for its new hardship exception request form, CMS states that multiple providers and provider types may apply as a group, using a single submission. Healthcare organizations can submit an electronic file with all National Provider Identifiers or CMS Certification Numbers for providers within a group. National Provider Identifiers for EPs and CMS Certification Numbers for eligible hospitals can also be included on the same application.

The new applications for hardship exceptions also require less information than the old ones did, CMS said.

Applications for EPs only, and applications for EPs and eligible hospitals, must be submitted by March 15 of this year. Applications that include only eligible hospitals must be in by April 1.

Physicians in five specialties do not need to submit the application. The specialties include anesthesiology, diagnostic radiology, interventional radiology, nuclear medicine, and pathology. In addition, new EPs who began to submit claims to Medicare in 2015 automatically receive exceptions to payment adjustments in 2016 and 2017, but must begin demonstrating meaningful use this year to avoid a penalty in 2018. Hospital-based EPs do not have to submit the form to avoid an adjustment.

There was not a huge falloff in the number of Medicare EPs attesting to meaningful use last year. In the 2014 program year, 228,007 EPs received meaningful use incentive payments; from January through November of 2015, nearly 183,000 did. But only 58,751 Medicare EPs received incentives in stage 2 of the program through last November compared with 307,656 who got paid in stage 1.

The big drop-off in stage 2 attestations cannot be attributed solely to the delay in CMS' delivery of its final rule. Many physicians simply found the stiffer requirements in stage 2 not worth the effort, especially as most of the incentive money was already gone.

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