August 2014 
Meaningful Use Update – Hardship Exemptions
Eligible professionals and eligible hospitals may be exempt from payment adjustments if they can show that a significant hardship has restricted their ability to demonstrating Meaningful Use in the required timeframe. To be considered for an exception, an eligible professional or eligible hospital may need to complete a hardship exception application along with proof of the hardship.  If approved, the hardship exception is valid for one payment year only.  A new application must be submitted if the hardship continues for the following payment year.  In no case may a provider be granted an exception for more than five years.  Eligible professionals can use the Hardship Exception Tool that is provided by Centers for Medicaid & Medicare Services (CMS) to determine if they will avoid the 2015 and 2016 Medicare Electronic Health Record (EHR) Incentive Program payment adjustments by demonstrating Meaningful Use, or if they should apply for a hardship exception.

The deadline for submitting a hardship exception application for 2015 (covering the 2013 attestation time period) for eligible providers (July 1, 2014) and eligible hospitals (April 1, 2014) has already passed. Hospital and providers who desire to apply for a hardship for subsequent penalties in 2016, based upon the 2014 reporting period, may apply for an exemption by April 1, 2015 for hospitals, and July 1, 2016 for eligible providers. CMS will review the application to determine whether or not you are granted a hardship exception.
Hardship Exceptions for Medicare Eligible Hospitals and CAHs
Eligible hospitals and critical access hospitals (CAHs) may apply for hardship exceptions to avoid the payment adjustments described above. Hardship exceptions will be granted only under specific circumstances and only if CMS determines that providers have demonstrated that those circumstances pose a significant barrier to their achieving Meaningful Use.
Medicare Subsection (d) eligible hospitals and CAHs can apply for hardship exceptions in the following categories:
Infrastructure: An eligible hospital or CAH must demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband).
New Eligible Hospitals: An eligible hospital or CAH with new CMS Certification Numbers (CCNs) that would not have had time to become Meaningful Users can apply for a limited exception to payment adjustments. The hardship exception is limited to one full-year cost reporting period.
Unforeseen Circumstances: Examples may include a natural disaster or other unforeseeable barriers.
The following hardship category is limited to Subsection (d) eligible hospitals and does not apply to CAHs:
“To be considered for an exception, an eligible
professional or eligible
hospital may need to
complete a Hardship
Exception application
along with proof of the
hardship.”

Jim Deren
Healthcare IT Planning
Specialist
CareTech Solutions

EHR Vendor Issues: The hospital’s EHR vendor was unable to obtain 2014 certification or the hospital was unable to implement Meaningful Use due to 2014 EHR certification delays.
Hardship Exceptions for Medicare Eligible Hospitals and CAHs
Eligible professionals may apply for hardship exceptions to avoid the payment adjustments described above. Hardship exceptions will be granted only under specific circumstances and only if CMS determines that providers have demonstrated that those circumstances pose a significant barrier to their achieving Meaningful Use.
Eligible professionals can apply for hardship exceptions in the following categories:  
Infrastructure: Eligible professionals must demonstrate that they are in an area without sufficient Iiternet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband).
New Eligible Professionals: Newly practicing eligible professionals who would not have had time to become Meaningful Users can apply for a two-year limited exception to payment adjustments. Thus eligible professionals who begin practice in calendar year 2015 would receive an exception to the penalties in 2015 and 2016, but would have to begin demonstrating Meaningful Use in calendar year 2016 to avoid payment adjustments in 2017.
Unforeseen Circumstances: Examples may include a natural disaster or other unforeseeable barrier.
Patient Interaction: Lack of face-to-face or telemedicine interaction with patient or lack of follow-up needed with patients.
Practice at Multiple Locations: Lack of control over availability of certified EHR technology (CEHRT) for more than 50 percent of patient encounters.
2014 EHR Vendor Issues: The eligible professional’s EHR vendor was unable to obtain 2014 certification or the eligible professional was unable to implement Meaningful Use due to 2014 EHR certification delays.
Not All Providers Are Required to Apply for Hardship Exceptions

·         New providers in their first year (both eligible professionals and eligible hospitals)

·         Eligible professionals 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 (Place of Service 21) or emergency department (Place of Service 23) of a hospital

·         Misc. Error (12%)  Eligible professionals with certain Provider Enrollment, Chain and Ownership System (PECOS) specialties (05, 22, 30, 36, 94)

Regardless of your organization’s current Meaningful Use situation, a well-developed risk management plan should be in place and include understanding your options to deal with potential hardships that may occur.  

Upcoming Meaningful Use topic: Security – What You Need to Know and Updates


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