The Centers for Medicare and Medicaid Services (“CMS”) continues to work to ensure it is responsive to providers who tried to meet meaningful use standards in 2015 but faced hardships in their efforts. Eligible professionals, eligible hospitals & critical access hospitals (“CAH”) now have until July 1, 2016 to apply to CMS for the Medicare EHR Incentive Program hardship exception under the new, streamlined process under the Patient Access and Medicare Protection Act (“PAMPA”), signed by the President in December 2015. CMS indicates on its website that the extension is to ensure “providers have sufficient time to submit their applications to avoid the 2017 payment adjustment.”  Eligible providers who did not meet meaningful use standards for 2015 receive an adjustment to their 2017 payment unless CMS grants a hardship exception.

Providers from the same group may apply for hardship under a single form. CMS may grant the hardship exception for

  • insufficient internet connectivity;
  • extreme and uncontrollable
    • natural disaster,
    • practice or hospital closure,
    • bankruptcy and debt restructuring,
    • EHR certification/vendor issues or
    • lack of control over the Certified EHR Technology (“CHERT”); or
  • lack of face-to-face patient interaction or follow-up.

The application form can be found here and CAHs should use the form found here.  The categories for hardship for CAHs do not include extreme and uncontrollable lack of control over the CHERT or lack of face-to-face patient interaction or follow-up.

CMS will grant an automatic exemption to the 2017 payment adjustment to certain hospitals and professionals. New eligible hospitals are those that obtain a new CMS certification number from October 1, 2014 to September 30, 2016 and benefit from the automatic exemption.  CMS will obtain data from the Medicare Provider Enrollment, Chain and Ownership Systems (“PECOS”) to determine eligibility for the automatic exemption for new hospitals. As well, these categories will receive an automatic exemption:

  • new eligible professionals;
  • eligible professionals with any of the following specialties as the primary area of practice
    • anesthesiology (05),
    • diagnostic radiology (30),
    • interventional radiology (94),
    • nuclear medicine (36) or
    • pathology (22); and
  • hospital-based eligible professionals for calendar year 2015

CMS determines if an eligible professional is new depending upon when the eligible professional starts submitting Medicare claims.  Eligible professionals who start submitting claims in 2015 receive an exception for calendar years 2016 and 2017.

For background, the Medicare EHR Incentive Program has several stages as follows:

  • Stage 1 established the requirements for the electronic capture of clinical data, including providing patients with electronic copies of health information.
  • Stage 2 focused on ensuring that there is meaningful use of EHRs.  Meaningful use includes continuous quality improvement at the point of care and the structured exchange of information.
  • In October 2015 CMS specified the criteria that eligible hospitals, CAHs and eligible professionals must meet to participate in the EHR Incentive Programs in 2015 to 2017 (Modified Stage 2) and in Stage 3 in 2017 and thereafter.