Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment

Medicare Eligible Professionals: Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment

Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.

The Hardship Exception applications and instructions  for an individual  and for multiple  Medicare eligible professionals are 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 a circumstance beyond your control.

• Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use.

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.

You do not need to submit a hardship application if you:

• are a newly practicing eligible professional

• 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 (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22; or

• Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)

CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception.

Apply by July 1
As a reminder, the application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2015 to be considered.

If approved, the exception is valid for the 2016 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:

• Medicaid only
• No claims to Medicare
• Hospital-based

Below are the CMS Hardship Exception applications (see links below) that providers will need to submit by July 1, 2015. Providers will submit this application if they did not successfully participate in the Medicare EHR Incentive program in 2014. The application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2015 to be considered.

• Hardship Exception 2016 – EP Application, Multiple NPIs
• Hardship Exception 2016 – EP Application
• Hardship Exception 2016 – EP Instructions

In a Q&A session recently, CMS said that providers do not have to submit any documentation to claim the exception for being unable to upgrade to 2014 Edition software.  They should, however, keep documentation of the issue in their files, in case they are audited.

Please note: This is a clarification point for the original announcement.

Want more information about the EHR Incentive Programs? 
Visit the EHR Incentive Programs website for the latest news and updates on the programs.

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