The EHR program is structured as an incentive program to strongly encourage EHR adoption. However, Congress did anticipate that there might be some holdouts or those for whom the amount of the initial incentive payments was not sufficient enough to accomplish its goal. Therefore, ARRA requires that physicians who do not meet the program criteria face penalties in 2015.

As part of the Stage 2 rule, CMS set forth the criteria for avoiding the payment adjustment, including exemptions to the EHR requirements. Specifically, you will be subject to the payment adjustment if you do not meet the EHR Incentive Program requirements and attest to doing so by October 1, 2014. CMS will make determinations regarding the payment adjustment based on data reported and attested to in 2013 if you begin participating by then. Those who begin participation in 2014 must complete the 90-day reporting period and attest to this by October 1, 2014. This includes all reporting of CQMs. Going forward, eligibility for the payment adjustment will be calculated in a manner similar to the e-prescribing and PQRS payment adjustments: a full reporting period two years before the applicable payment year, or for those in their first year of reporting, completion of program requirements, including attestation, by the end of the third quarter of the year preceding the payment year.

Payment Adjustment Schedule for 2015 and Beyond if Less Than 75 percent of EPs Successfully Participate in the EHR Incentive Program by 2018 and Beyond

EPs who are not successful participants

2015

2016

2017

2018

2019

2020+

Not subject to e-prescribing payment adjustment for 2014

99%

98%

97%

96%

95%

95%

Subject to e-prescribing payment adjustment for 2014

98%

98%

97%

96%

95%

95%

 

Those who do not meet the eligibility requirements for the program are automatically excluded from the payment adjustment. Alternatively, CMS has created a number of hardship exceptions to the payment adjustment for which you may qualify. Exceptions will be determined on a case-by-case basis and subject to annual renewal, but will not exceed five years. To ensure that you are not penalized if you do qualify for one of the exceptions, make sure to pay close attention to the deadlines for applying for the appropriate exception.

Hardship exception categories:

  • New EPs: Newly practicing EPs who would not have had time to become meaningful users can apply for a 2-year limited exception to payment adjustments. Thus, EPs 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.
  • By Specialist/Provider Type: EPs must demonstrate that they meet all three of the following criteria:
    • Lack of face-to-face or telemedicine interaction with patients
    • Lack of follow-up need with patients
    • Lack of control over the availability of Certified EHR Technology at their practice location. (EPs who practice at multiple locations may be granted a hardship exception solely for lack of control over the availability of Certified EHR Technology)

For more information on applying for a hardship exception, visit the CMS website.

Auditing and Document Retention

CMS reserves the right to audit the records of selected physicians to ensure compliance. The intention of the reviews is to validate physician verifications of successful participation. You are required to maintain documentation of program requirements for 10 years after registration.

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