Home Forums Discussions Meaningful Use Avoiding the MU penalty from 2015

Whether or not the MU program will end in future years (to be replaced by MIPS) it is important to understand that MU is still in place from 2015. If you see Medicare patients and did not participate in MU, you will be subject to a 2% cut for your 2017 payments UNLESS you apply for a hardship exemption.

The "PAMPA" bill which passed in December is supposed to provide a hardship exemption to anyone who applies ("A letter from Rep. Pete Sessions...sheds some light. After a private meeting earlier this month with CMS officials, Sessions was assured CMS would grant exemptions under a streamlined process for all those who sought them" as referenced here.

Instead of simply exempting everyone, you must apply for the exemption to avoid the cut.

The final CMS ruling is apparently out, and you have until 3/15/16 to submit your form: https://www.cms.gov/Regulations-and...centivePrograms/paymentadj_hardship.html

The application form, which is available from that website is very brief (mostly simple demographic information). It really only asks one "difficult" question, and that is "why are you seeking the exemption". It gives several choices to choose from, and based on Sessions' message, it should not matter which one you pick. Still, it would be nice to pick one that is accurate. Unfortunately, there is no option for "other reasons" such as the most important one: "CMS didn't release the final rules until there were fewer than 90 days left in the year so even IF I wanted to do MU, I wouldn't know how to comply until it was too late".

My suggestion is that people complete the form, choosing a reason for the hardship, if one is appropriate to your situation. My plan is to complete the brief form, leaving the reason for the hardship blank. If CMS is true to their word, then the exemption is available to ALL those who request it and should be granted.

Deadline for submission is 3/15/2016.

Thanks Jon
Will do it, don't expect it will work but what the heck.

Thanks, Jon.
I completed it.
It looks like 2.2.d applies: "issues related to insufficient time to make changes to the CEHRT to meet CMS regulatory requirements for reporting in 2015".
Given that they did not change the reporting requirement to 3 months until we were already into the last quarter.

Donna, I understand that we could not take the steps to meet the requirements due to their late release. But I took the verbiage in 2.2.d to mean that the EHR didn't have time to meet the requirements. Wasn't the version of AC that was certified through the second half of 2015 already certified for MU? If so, how can we claim there was insufficient time to make changes to the EHR?

I am taking it to mean that by the time they released the decision, I did not have time to upgrade software, train and report for the last quarter. That is, I did not have time to make the EHR changes in my office, not that the EHR had not been certified. Had they released the decision earlier in the year, I may have done it.

Works for me. I sent the form without checking any choice; will let you know how that works. If I am not approved, I will go with 2.2.d.
Oh, and if they fine me, I will forward the bill to you.

Yesterday CMS issued a "clarification" which makes it clearer that they are essentially willing to waive the penalty for everyone (as promised) and that Donna is correct (no surprise there) that 2.2.d is the appropriate selection.

Key quotes from the CMS statements include "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 final rule, a provider may apply for a hardship exception".

And "CMS does not require an EP, eligible hospital, or CAH ? or any group of providers ? to submit documentation for the hardship category selected and CMS will not be reviewing documentation supporting the application on a case-by-case basis. CMS will review the application to record the category selected and use the identifying information to approve the hardship exception for each provider listed on the application. Providers should retain documentation of their circumstances for their own records, but no such documentation is required for review by CMS. "

In my opinion, everyone who sees Medicare patients should take this simple step to avoid a 2% cut in 2017.

Thanks for the update, Jon.

Does anyone have an idea what will happen in 2016 with meaningful use step 2 if you take the hardship exemption? Will 2016 still be a 90 day reporting period, since (in my case) its my first time through step 2 (i.e. everything just pushed back a year), or will they act like you passed Step 2 year 1 and make 2016 a full 12 mos reporting period?

Meaningful use appears to be over.
See this thread MU dead

I'd like to think you're right, Donna, but it ain't over 'til its over, and that could be several more years.

Regarding the Hardship Exemption, there is this from CMS: "Providers who experienced an issue with their CEHRT related to the rule timing ? and any other provider for whom the TIMING of the rule caused a significant hardship ? should select sub-category 2.2d on the 2017 hardship exception application. No additional documentation is required for this selection". So its definitely 2.2d.

And, I may have found the answer to my own question, in that the CMS 2016 Reporting Requirements page says: "EHR Reporting Period: For all returning participants, the EHR reporting period will be a full calendar year from January 1, 2016 through December 31, 2016". So, if you have previously reported (i.e. done any Step 1), 2016 is a full calendar year of data. Only newbies to MU (Step 1, year 1) get to do 90 days in 2016. [Unless they further change it].

Thank you all for this.
I just submitted my application.

Michigan, I can't speak for the AMA- and would never want to - but I suspect the idea is this:
If you apply for the exemption, it will essentially be granted automatically.
If you attest for MU, there is always the chance that they will find something wrong and you will be denied. Or perhaps audited later.
So their suggestion is to take the exemption, even if you have already attested.

Thanks for letting all of us know about the hardship exemption, Jon. Most were resigned to a Medicare cut in 2017 because Stage 2 was so onerous. This will really help if CMS comes through as promised.

Anyone see a pattern here? Congress & CMS talk tough (SGR, Meaningful Use), then spend years backpedalling and finally bail out, "imagineering" the next great "alternative payment model". Many of the ACOs seem to be on life support. Most physicians collected 80% of the MU payments without ever getting past Stage 1. The planned "merit based payment program" appears to be a rehash of the British NHS Quality and Outcomes Framework, which nearly bankrupted NHS in the first year.

Government will never change. These are the people who spend $200 for hammers.

HI everyone: quick question. I did not do MU I in 2014 basically because I was dealing with breast cancer and chemo for the past year. A little preoccupied with survival but can I apply using 2.2.d.....they do not seem to offer near death experiences with health issues. I quess the question is was Amazing Chart caught in the crosshairs of that hardship rule. The last thing I want to do is go to jail. Gwendolyn O'Guin, D.O. Maine (i am doing fine by the way) I have been using AC since 2014.

Gwendolyn,
Sorry to hear about your health issues... hopefully they are in the rear view mirror now.

The hardship exemptions do not refer to an issue specific to AC. You had to follow the MU criteria for 90 days to attest, but the rules were not released until October, with less than 90 days left in the year. So ANYONE using any EMR who said, "I really want to satisfy MU. I will start just as soon as the final rules are out, so I can be sure I follow them".... would be unable to attest.

The reality is that CMS should have simply said they will not assess any penalties. Instead, they are saying that anyone who asks for an exemption will get one, but if you don't fill out the form, you lose the money.

CMS extended the application deadline for the Medicare EHR Incentive Program hardship exception process that reduces burden on clinicians, hospitals, and critical access hospitals (CAHs). The new deadline for Eligible Professionals, Eligible Hospitals & CAHs is July 1, 2016.

CMS extended the deadline so providers have sufficient time to submit their applications to avoid the 2017 payment adjustment. For more information, including the applications, please click here

FAQ12845 explains the 2.2d option which is related to the timing of the publication of the Final Rule.
https://questions.cms.gov/faq.php?faqId=12845&id=5005&r=p

Best course of action is CYA by submitting the application even if you have attested to MU for 2015.....jmo

Hooray, I got my approval for MU hardship exception today for 2017!

Thanks, Jon. I'd split the 2% that I won't be losing with you...but probably that would be a Stark violation. So I guess it's just thanks a lot for alerting us.

Nice, hopefully MIPS and MACRA don't get you/us