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Medicare Eligible Professionals: Take Action Today to Avoid 2016 Medicare Payment Adjustments

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 applying today 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.

Please note: The application includes specific instructions for documentation requirements for each category, please check the instructions and form carefully for the documentation for the category for which you are applying. While supporting documentation must be provided for certain hardship exception categories, CMS does not require additional documentation for 2014 Edition certified EHR technology issues. You should, however, retain documentation for your own records. CMS will independently review each application and any supporting documentation.

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 Today

As a reminder, the application must be submitted electronically or postmarked no later than 11:59 p.m. ET today 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

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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