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Payment Adjustments & Hardship Exceptions

Payment Adjustments

In the American Recovery and Reinvestment Act of 2009 (ARRA), Congress mandated that payment adjustments should be applied to Medicare eligible professionals and eligible hospitals who are not meaningful users of Certified Electronic Health Record (EHR) Technology under the Medicare EHR Incentive Program.

If a provider is eligible to participate in the Medicare EHR Incentive Program, they must demonstrate meaningful use in either the Medicare EHR Incentive Program or in the Medicaid EHR Incentive Program, to avoid a payment adjustment. Medicaid providers who are only eligible to participate in the Medicaid EHR Incentive Program are not subject to these payment adjustments.

These payment adjustments will be applied beginning on October 1, 2014 for hospitals and on January 1, 2015 for Medicare eligible professionals.

Hardship Exception Applications to Avoid the 2015 Medicare Payment Adjustment

CMS is announcing its intent to reopen the submission period for hardship exception applications for eligible professionals and eligible hospitals to avoid the 2015 Medicare payment adjustments for not demonstrating meaningful use of Certified Electronic Health Record Technology (CEHRT). The new deadline will be 11:59 PM EST November 30, 2014.

Who is eligible for a Hardship Extension Application?

  • Eligible Professionals or Eligible Hospitals that are new to the EHR Incentive Program and have been unable to fully implement 2014 edition certified electronic health records technology (CEHRT) due to delays in 2014 edition CEHRT availability.
  • Eligible Professionals who were unable to attest by October 1, 2014 and Eligible Hospitals that were unable to attest by July 1, 2014 using the flexibility options provided by the CMS 2014 CEHRT Flexibility Rule.

Hardship Extension applications submitted by providers that attested in 2011 and/or 2012 will not be approved because this application is only for providers new to the EHR Incentive Program.

If you have attested to Medicare meaningful use in 2013 and/or 2014 you do not need to apply for this hardship because you are already exempt from the 2015 Medicare payment adjustment.

Application Submission Instructions and Tips:

  • The submission due date for the Hardship Extension Application is 11:59 PM EST on November 30, 2014.
  • The application should be completed as a dynamic PDF form available for download via the following link  http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/HardshipExtension_Application.pdf
  • The application should be submitted via email to ehrhardship@providerresources.com
  • Do not submit hand-written applications unless absolutely necessary. This may result in processing delays.
  • Do not fax applications unless absolutely necessary. This may result in processing delays.
  • If you are an Eligible Professional, you must complete this from using your individual National Provider Identifier (NPI).
    • Applications submitted for Group NPIs or physician group practices will not be processed.
    • Multiple NPI Addendums will not be accepted or processed.
  • Do not apply if you previously attested for 2011 or 2012. Hardships will only be approved for providers that are new to the EHR Incentive Program.
  • Do not apply if you attested to Medicare meaningful use in 2013 and/or 2014. You are already exempt from the 2015 Medicare payment adjustment.

Hospital Payment Adjustment Reconsideration Application

If you feel the hospital is subject to the payment adjustment for Medicare in error, please refer to the following instructions and application to apply for payment adjustment reconsideration for Fiscal Year 2015:

       Note: This application is only for hospitals that are subject to the payment adjustment in 2015.

Hardship Exceptions

Eligible professionals and eligible hospitals may be exempt from payment adjustments if they can show that demonstrating meaningful use would result in a significant hardship.  To be considered for an exception, an eligible professional or eligible hospital must complete a Hardship Exception application along with proof of the hardship.  If approved, the hardship exception is valid for 1 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 5 years.

Eligible professionals can use the Hardship Exception Tool to determine if they will avoid the upcoming 2015 and 2016 Medicare EHR Incentive Program payment adjustments by demonstrating meaningful use, or if they should apply for a hardship exception.

Eligible Professional (EP) Hardship Exception Application

  • 2015 Eligible Professional Hardship application deadline was July 1, 2014
  • 2016 Eligible Professional Hardship application will be available soon.

Eligible Hospitals Hardship Exception Application

  • 2015 Eligible Hospital Hardship application deadline was April 1, 2014
  • 2016 Eligible Hospital Hardship application will be available soon.

Not All Providers Apply for Hardship Exceptions
Some providers will automatically be granted a hardship exception for 2015. CMS will use Medicare data on these providers to determine their hardship exception.

The following providers do not need to submit a hardship application:

  • 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*
  • Eligible professionals in which 90% of their claims include Place of Service 21, Place of Service 23 and certain observation services using Place of Service 22.
  • Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology) 6 months prior to the first day of the payment adjustments. Eligible professionals should verify that their PECOS specialty is up to date.

*Please register in the CMS Registration & Attestation System to determine hospital-based status.  .