What are the exclusions for Meaningful Use?

What is an exclusion?

Exclusions are CMS specified exemptions from completing certain criteria and can be claimed during attestation. If you qualify for an exclusion, you do not need to complete  that measure and you can still receive a full incentive payment or avoid penalties if you achieve all of the remaining objectives.


When and where do I claim an exclusion?

Exclusions will be claimed during attestation (e.g. when completing the online attestation process with CMS or your state Medicaid agency) at the end of your reporting period.


What are the exclusions for my specialty?

Some exclusion definitions may be universally or nearly universally applicable to a specialty due to their scope of practice. However, because there is no blanket exclusion for any type of provider, specialists must individually evaluate whether they meet the exclusion criteria for each applicable measure.


Maintaining documentation of your exclusions

You will not need to submit any documentation to CMS or Medicaid during the attestation process to claim an exclusion. However, you need to be prepared to prove you qualify for an exclusion in case of an audit; this means you should retain any documentation that supports your qualification for the exclusion. This documentation could be email exchanges with CMS or Medicaid, information that confirms your specialty or practice locations, etc. For some measures, the Meaningful Use Dashboard will display a value of zero for the denominator if you do not see any patients who meet the criteria. You should maintain a copy (screenshot or printed copy) of your Meaningful Use Dashboard with those values if you claim an exclusion for those measures.


There are exclusions for several Meaningful Use criteria. We cannot confirm whether you are eligible for an exclusion, but we can help you understand the requirements. You must make this decision in consultation with CMS, if necessary. Contact your regional CMS representatives for questions pertaining to Meaningful Use exclusions.


The following is a list of Stage 2 measures and their associated exclusions. Please read each exclusion carefully to understand if it applies to you:


Objective 1: Protect Patient Health Information

  • No available exclusions


Objective 2: Clinical Decision Support

  • Exclusion: Any eligible provider who writes fewer than 100 medication orders during the EHR reporting period is excluded from the second measure of this objective (enabling drug-drug and drug-allergy interaction checks).


Objective 3: Computerized Provider Order Entry (CPOE)

  • Exclusion: Any provider who writes fewer than 100 medication, radiology, and/or laboratory orders during the EHR reporting period is excluded from the corresponding measure.

  • Alternate Exclusion: Providers who began Meaningful Use in 2015 or 2016 have the option to claim an alternate exclusion for measure 2 (laboratory orders) and measure 3 (radiology orders).

Objective 4: Electronic Prescribing (eRx)

  • Exclusion: Any provider who:

  • Writes fewer than 100 prescriptions during the EHR reporting period

  • Doesn’t have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the practice location at the start of the reporting period.


Objective 5: Health Information Exchange

  • Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period is excluded from this objective.


Objective 6: Patient Specific Education

  • Exclusion: Any EP who has no office visits during the EHR reporting period.


Objective 7: Medication Reconciliation

  • Exclusion: Any EP who was not the recipient of any transitions of care during the EHR reporting period is excluded from this measure.


Objective 8: Patient Electronic Access

  • Exclusion: Any provider who:

  • Doesn’t order or create any of the information listed for inclusion as part of both measures.

  • Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.


Objective 9: Secure Electronic Messaging

  • Exclusion: Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing  units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.


Objective 10: Public Health

  • Exclusion for Measure 1 Immunization Registry: Any eligible provider meeting one or more of the following criteria may be excluded from the immunization registry reporting sub-measure if the eligible provider:

  • Does not administer any immunizations to any of the populations for which data is collected by its jurisdiction's immunization registry or immunization information system during the EHR reporting period.

  • Operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required to meet the CEHRT definition at the start of the EHR reporting period

  • Operates in a jurisdiction where no immunization registry or immunization information system has declared readiness to receive immunization data from the EP at the start of the EHR reporting period.

  • Exclusion for Measure 2 Syndromic Surveillance: Any eligible provider meeting one or more of the following criteria may be excluded from the syndromic surveillance reporting measure if the provider:

  • Is not in a category of providers from which ambulatory syndromic surveillance data is collected by their jurisdiction's syndromic surveillance system;

  • Operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data in the specific standards required by CEHRT at the start of their EHR reporting period;

  • Operates in a jurisdiction where no public health agency has declared readiness to receive syndromic surveillance data from EPs at the start of the EHR reporting period.

  • Exclusion for Measure 3 Specialized Registry Reporting: Any eligible professional (EP) that meets at least 1 of the following criteria may be excluded from this objective:

  • Does not diagnose or treat any disease or condition associated with or collect relevant data that is required by a specialized registry in their jurisdiction during the EHR reporting period.

  • Operates in a jurisdiction for which no specialized registry is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period.

  • Operates in a jurisdiction where no specialized registry for which the EP, eligible hospital, or CAH is eligible has declared readiness to receive electronic registry transactions at the beginning of the EHR reporting period.

  • Exclusion updates for 2016: Providers should be able to claim an alternate exclusion to both Syndromic Surveillance and Specialized Registry Reporting, 2 of the 3 measures for Objective 10. If providers immunize patients, they will need to complete the Immunization Registry Reporting requirements. If they do not immunize patients, then they will claim an exclusion to all three measures to meet the overall objective. Please see  FAQ #14397 and  FAQ #14401 for more details, and contact CMS if you have additional questions.



Meaningful Use

  1. What is Meaningful Use?
  2. How does the Meaningful Use Dashboard work?
  3. How do I attest for Meaningful Use?
  4. What are the Modified Stage 2 Meaningful Use requirements for 2017?
  5. What are the exclusions for Meaningful Use?
  6. What patients are counted for Meaningful Use?
  7. How do the components of a chart note relate to Meaningful Use?
  8. How do I print the Meaningful Use Dashboard?
  9. How do I minimize or refresh CDS notifications?
  10. How can I send a referral using Direct Messaging?
  11. Medicaid Meaningful Use Stage 2 Objective 8: Patient Electronic Access
  12. How does patient portal access and auto-invite relate to Meaningful Use?
  13. Medicaid Meaningful Use Stage 2 Objective 9: Secure Electronic Messaging
  14. Medicaid Meaningful Use Stage 2 Objective 2: Clinical Decision Support
  15. What constitutes a "unique" patient?
  16. Meaningful Use attestation for previous years
  17. Medicaid Meaningful Use Stage 2 Objective 3: CPOE for Medication, Lab, and Radiology Orders
  18. Medicaid Meaningful Use Stage 2 Objective 10: Public Health - Specialized Registry Reporting
  19. How do Meaningful Use payment adjustments work?
  20. How do I apply for a Meaningful Use Hardship Exception?
  21. Medicaid Meaningful Use Stage 2 Objective 7: Medication Reconciliation
  22. Medicaid Meaningful Use Stage 2 Objective 5: Health Information Exchange
  23. Medicaid Meaningful Use Stage 2 Objective 1: Protect Patient Health Information
  24. What is Practice Fusion's certification number (ID)?
  25. How do I register for the Medicaid Meaningful Use Program?
  26. Can I change, modify, or cancel my attestation?
  27. How do I choose my reporting period duration for Medicaid Meaningful Use?
  28. How do I calculate percentages for Meaningful Use with multiple EHRs?
  29. Medicaid Meaningful Use Stage 2 Objective 4: Electronic Prescribing (eRx)
  30. Medicaid Meaningful Use Stage 2 Objective 10: Public Health - Immunization Registry Data Submission
  31. Is Practice Fusion certified as a 2014 Meaningful Use Complete EHR?
  32. Patient records maintained in the EHR for Meaningful Use attestation
  33. How do I get my AIU letter from Practice Fusion?
  34. How do I report Clinical Quality Measures for Meaningful Use?
  35. Medicaid Meaningful Use Stage 2 Objective 6: Patient-Specific Education
  36. Do I have to meet all 10 objectives to achieve Meaningful Use?
  37. Can I participate in both MIPS (Medicare) and Meaningful Use (Medicaid)?
  38. Are there patient education materials available in Spanish?
  39. How do I select or change my reporting period start date?
  40. When do I need to sign chart notes for Meaningful Use? Can I sign a chart after the reporting period?
  41. How do I contact CMS about the EHR Incentive Program?
  42. What is QCDR?
  43. How do I qualify for Meaningful Use if I see patients in multiple locations?
  44. How many exclusions can each provider claim for meaningful use?
  45. Can I use multiple EHR's to qualify for Meaningful Use?
  46. Medicaid Meaningful Use Stage 2 Objective 10: Public Health - Syndromic Surveillance Data Submission
  47. Does Practice Fusion support Patient-Centered Medical Home (PCMH)?
  48. Medicaid Meaningful Use Stage 2 Objective 10: Public Health Reporting
  49. What stage of Medicaid Meaningful Use am I in?
  50. How do I prepare for the PQRS Penalty Informal Review?
  51. How do I prepare for a Meaningful Use audit?
  52. What is Data Portability?
  53. How can I report CQMs for PQRS?
  54. Diabetes: Low Density Lipoprotein (LDL) Management (CMS 163v4)
  55. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control (CMS 182v5)
  56. Use of Appropriate Medications for Asthma (CMS 126v4)

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