Meaningful Use Exemption Information

2016-02-26 | , American Association of Orthopaedic Surgeons

UPDATE: CMS extended the deadline for meaningful use hardship exemption applications to July 1, "so providers have sufficient time to submit their applications to avoid adjustments to their Medicare payments in 2017," the agency said. The original deadline was March 15 for doctors.

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Last month, President Barack Obama signed into law S. 2425, the Patient Access and Medicare Protection Act (PAMPA), which was established with respect to the payment adjustment for 2017 and allows the Centers for Medicare and Medicaid Services (CMS) to consider hardship exceptions for categories of eligible professionals and hospitals in a new, more streamlined process. Importantly, the legislation requires that CMS provide a blanket hardship exemption from 2015 meaningful use penalties to all providers who ask for it. Late last month, CMS released the details on applying for the hardship exemption.

Physicians will find both an individual and a group option allowing multiple physicians to apply for a hardship exception on a single application. The individual filling out the information may be the physician applicant him/herself or it may be another individual filing out the information on behalf of the physician group. The hardship exception categories are the same for both groups and individuals – AAOS suggests members to use the exemption category, “EHR Certification/Vendor Issues (CHERT Issues)” (option 2.2.d in the application), which will be open to ALL physicians because of the delay in publication of the program’s modifications.

Applications and more information can be found online here.

INSTRUCTIONS FOR COMPLETING AND SUBMITTING THE APPLICATION

  • Electronic submission of this application is strongly recommended as submitting hardcopy or faxed applications may result in processing delays. If electronic submission is not possible, please TYPE or PRINT all information using blue or black ink; do not use pencil.
  • Please download the application and type in the dynamic form. Attach the completed application to an email and send to ehrhardship@provider-resources.com.
  • If an electronic submission is not feasible, this application can be submitted via fax to 814-456- 7132.
  • If approved, the hardship exception is applicable for only the 2017 payment adjustment year.
  • Determinations made by CMS or their designee regarding hardship exception applications are final and cannot be appealed.
  • All hardship exception determinations will be returned via email from ehrhardship@providerresources.com to the email address provided on the application.
  • Provider identification information must include the individual NPI for each EP included on the application. Failure to provide the individual NPI will result in a determination delay of the hardship exception application.
  • CMS will accept provider identification information (NPI and CCN) submitted within the form in the section provided or as a Microsoft Excel (.xls) or Microsoft Excel Open XML spreadsheet (.xlsx), comma delimited (.csv) or text file (.txt) format. These files must be submitted with the application and directly accessible through the email attachment.
  • Retain a copy of your completed hardship exception application for your records.

If an EP, eligible hospital or Critical Access Hospital (CAH) is unable to effectively plan for a reporting period in 2015 due to the timing of the publication of the 2015 through 2017 Modifications final rule, can they apply for a hardship exception?

Yes, if a provider is unable to meet the requirements of meaningful use for an EHR reporting period in 2015 for reasons related to the timing of the publication of the final rule, a provider may apply for a hardship exception. 

For the hardship exception for the 2017 payment adjustment, CMS is required to use the categories defined for a hardship on the CMS website as of December 15, 2015.   Through inquiries to CMS, providers have expressed that a primary concern related to the rule timing is in making any system changes, including to calculations or reports, in time to succeed in 2015. Therefore, the sub-category for issues related to the 2015 rulemaking timeline is included under the existing category for extreme and uncontrollable circumstances related to the implementation and use of CEHRT (Section 2.2d).

Providers who experienced an issue with their CEHRT related to the rule timing and any other provider for whom the timing of the rule caused a significant hardship should select sub-category 2.2d on the 2017 hardship exception application. 

CMS does not require a provider or group of providers to submit documentation for this or any other hardship category selected and CMS will not be reviewing documentation supporting the application on a case-by-case basis.  CMS will review the application to record the category selected and use the identifying information to approve the hardship exception for each provider listed on the application.  Providers should retain documentation of their circumstances for their own records, but no such documentation is required for review by CMS.

On the new hardship application form for the 2017 payment adjustment, there is nothing which says documentation is required to be submitted with the application form. Does this mean that CMS will only require the selection of a hardship category and the completion of the provider’s identifying information in order to approve a hardship exception?  Or will CMS be reviewing the application and documentation on a case-by-case basis for each provider?

CMS does not require an EP, eligible hospital, or CAH – or any group of providers – to submit documentation for the hardship category selected and CMS will not be reviewing documentation supporting the application on a case-by-case basis. CMS will review the application to record the category selected and use the identifying information to approve the hardship exception for each provider listed on the application. Providers should retain documentation of their circumstances for their own records, but no such documentation is required for review by CMS.

Can a provider register their intent after the first 60 days of the reporting period in order to meet the measures if a registry becomes available after that date?

If a registry declares readiness at any point in the calendar year after the initial 60 days, a provider may still register their intent to report with that registry to meet the measure under Active Engagement Option 1. However, a provider who could report to that registry may still exclude for that calendar year if they had already planned to exclude based on the registry not being ready to allow for registrations of intent within the first 60 days of the reporting period.

What should a provider do in 2016 if they did not previously intend to report to a public health reporting measure that was previously a menu measure in Stage 2 and they do not have the necessary software in CEHRT or the interface the registry requires available in their health IT systems? What if the software is potentially available but there is a significant cost to connect to the interface?

In the 2015 EHR Incentive Programs Final Rule, we stated that we did not intend for providers to be inadvertently penalized for changes to their systems or reporting made necessary by the provisions of that regulation. This included alternate exclusions for providers for certain measures in 2016, which might require the acquisition of additional technologies they did not previously have for measures they did not previously intend to include in their activities for meaningful use (80 FR 62945). Therefore, in order that providers are not held accountable to obtain and implement new or additional systems, we will allow providers to claim an alternate exclusion from certain public health reporting measures in 2016 if they did not previously intend to report to the Stage 2 menu measure... read the full FAQ.

For 2016, what alternate exclusions are available for the public health reporting objective?  Is there an alternate exclusion available to accommodate the changes to how the measures are counted?

We do not intend to inadvertently penalize providers for changes to their systems or reporting made necessary by the provisions of the 2015 EHR Incentive Programs Final Rule. This includes alternate exclusions for providers for certain measures in 2016, which might require the acquisition of additional technologies they did not previously have or did not previously intend to include in their activities for meaningful use (80 FR 62945). For 2016, EPs scheduled to be in Stage 1 or Stage 2 must attest to at least 2 measures from the Public Health Reporting Objective Measures 1-3 and eligible hospitals or CAHs scheduled to be in Stage 1 or Stage 2 must attest to at least 3 public health measures from the Public Health Reporting Objective Measures 1-4… read the full FAQ.

What steps does a provider have to take to determine if there is a specialized registry available for them, or if they should instead claim an exclusion? Read the full FAQ.

What steps do eligible hospitals and Critical Access Hospitals need to take to meet the specialized registry objective? Is it different from EPs? Read the full FAQ.

What can count as a specialized registry? Read the full FAQ.