As an Eligible Professional (EP), you may be exempt from Medicare penalties if you can show that demonstrating Meaningful Use would result in a significant hardship. To be considered for an exemption, you must complete a Hardship Exception application along with the proof of the hardship. If approved, the hardship exemption is valid for only one payment year and you would need to submit a new application for subsequent years. In no case may a provider be granted an exemption for more than 5 years.
Update: per CMS, the deadline to submit an EHR Incentive Program Hardship Exception application to avoid the 2017 Medicare EHR payment adjustment has passed. For inquiries about Hardship Exception Applications, please email firstname.lastname@example.org.
Payment adjustments for eligible professionals who did not successfully participate in the Medicare EHR Incentive Program in 2015 will begin on January 1, 2017. Medicare eligible professionals could avoid the 2017 payment adjustment by taking action in 2016 and applying for a 2017 hardship exception. The deadline to apply for a 2017 hardship exception is July 1, 2016.
The Hardship Exception Applications and instructions for an individual and for multiple Medicare eligible professionals will become available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving Meaningful Use and how to apply. To file a hardship exception, you must:
Show proof of circumstances beyond your control
Explicitly outline how the circumstances significantly impaired your ability to meet Meaningful Use
Please note that the hardship exemption applications to avoid a penalty in 2016 were due in July of 2015. If you did not complete Meaningful Use successfully in 2014, and did not apply for the 2016 hardship exemption by July of 2015, you will receive penalties on your Medicare reimburse.
Supporting documentation must also be provided for certain hardship exception categories. CMS will review applications to determine whether or not a hardship exception should be granted.
*While Practice Fusion can provide the CMS specifications for hardship exceptions and CMS specifications, we cannot advise or recommend that a provider apply for a hardship exception.*
Your Hardship Exception Application must be submitted electronically or postmarked by the CMS deadline that they post on their website to be considered. You can email the completed documentation to email@example.com. If approved, the exception is valid for the 2017 payment adjustment only. If you intend to claim a hardship exception for a subsequent payment adjustment year, a new application must be submitted for the appropriate year. In addition, providers who are not considered eligible professionals under the Medicare program are not subject to payment adjustments and do not need to submit an application. Those types of providers include:
No claim to Medicare
EPs can apply for a hardship exemption in the following categories:
Infrastructure: Provider must demonstrate that they are in an area without sufficient internet access or face insurmountable barrier to obtaining infrastructure (e.g. lack of broadband).
New professionals (see below): Newly practicing professions can apply for a 2 year limited exception to penalties. Those who begin practice in 2015 would receive an exception to the penalties in 2015 and 2016, but would need to demonstrate Meaningful Use in 2016 to avoid penalties in 2017.
Unforeseen circumstances: Examples include a natural disaster or other unpredictable barrier.
Patient Interaction: Lack of face to face or telemedicine interaction with patient or lack of follow-up need with patients.
Practice at multiple locations: Lack of control over availability over certified EHR for more than 50% of patient encounters.
Extreme and Uncontrollable circumstances: 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 2015-2017 Modifications final rule, a provider may apply for a hardship exception under the “extreme and uncontrollable” circumstances category.
Some providers will automatically be granted a hardship exemption for 2015. The following providers do not need to submit a hardship application:
New providers enrolling in Medicare for the first year
EPs who are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient or emergency department of a hospital. Please register in the CMS Registration & Attestation System to determine hospital-based status.
EPs with certain specialties (Anesthesiology, Pathology, Diagnostic Radiology, Nuclear Medicine, or Interventional Radiology). Make sure to verify that your PECOS specialty is up to date.
For more information about the EHR Incentive Program, you should visit the Meaningful Use Center.