MU  Hardship  Excep0ons  Wednesday,  April  2,  2014  

Disclaimer:  Nothing  that  we  are  sharing  is  intended  as  legally  binding  or  prescrip7ve  advice.  This  presenta7on  is  a  synthesis  of  publically  available  informa7on  and  best  prac7ces.  

Agenda  

•  Introduc-ons    •  Background  •  Payment  Adjustments  •  What  is  Hardship  Excep-on?  •  Impact  of  Excep-on  •  MU  Hardship  Deadline  •  Who  Qualifies?  •  What’s  next?    •  Q&A  

Background  

•  Part  of  ARRA  (American  Recovery  and  Reinvestment  Act)  congress  mandates  adjustments  applied  to  EP’s  (eligible  professionals)  who  did  not  meet  MU  

•  Payment  adjustments  applied  star-ng  Jan  1,  2015  

•  Medicaid  only  providers  are  not  included  in  adjustments  

•  EP’s  who  did  not  meet  MU  in  beginning  of  2014  

•  Payment  adjustment  is  applied  to  the  Medicare  physician  fee  schedule  

•  Payment  adjustment  is  1%  per  year    

•  Payment  adjustment  is  cumula-ve  for  every  year  the  provider  does  not  meet  MU  

•  Payment  adjustments  begin  January  1,  2015  

Payment  Adjustments  

Adjustment  Impact  

•  If  75%  of  EP’s  meet  MU  by  2018  the  adjustment  caps  at  3%  

•  If  less  than  75%  of  EP’s  meet  MU  by  2018  the  adjustment  can  reach  as  high  as  5%  

Adjustment  Impact  Table  

>  75%  EP’s  MU   <  75  EP’s  MU  

2015   99%   99%  

2016   98%   98%  

2017   97%   97%  

2018   97%   96%  

2019   97%   95%  

2020   97%   95%  

EP’s  A[ested  Prior  to  2015    

•  EP’s  that  first  a[ested  in  2011  and  2012  must  demonstrate  MU  for  a  full  calendar  year  in  2013  

•  A\er  a[es-ng  EP’s  must  maintain  MU  compliance  every  calendar  year  therea\er  to  avoid  adjustments  

•  October  1,  2014  last  day  to  a[est  to  avoid  adjustment  in  2015  

What  is  the  Hardship  Excep-on  

•  An  excep-on  that  allows  EP’s  to  avoid  the  payment  adjustments  star-ng  in  2015  

•  Only  given  under  circumstances  outlined  by  CMS  •  CMS  determines  if  circumstances  pose  barrier  to  

achieving  MU  •  Provider  must  show  that  demonstra-ng  MU  would  result  

in  significant  hardship  •  Applica-on  must  be  submi[ed  in  addi-on  to  proof  of  the  

hardship  •  Hardship  will  last  for  one  year  •  Hardship  excep-on  can  be  u-lized  a  maximum  of  5  years  

Do  I  Qualify?  

•  EP’s  a[es-ng  for  first  -me  in  2014  but  unable  to  implement  CEHRT  

•  Payment  adjustments  only  apply  to  Medicare  Incen-ve  program  

•  Adjustments  do  not  apply  for  Medicaid  

Eligible  Providers  –  Infrastructure  – New  eligible  professionals  

– Unforeseen  circumstances  

– 2014  EHR  vendor  issues  

– Pa-ent  interac-on  – Prac-ce  at  mul-ple  loca-ons  

Eligible  Hospitals  

–  Infrastructure  – New  eligible  professionals  

– Unforeseen  circumstances  

– 2014  EHR  vendor  issues  

Reasons  for  Excep-on  

Infrastructure  

•  EP’s  must  demonstrate  they  are  without  sufficient  internet  access  

•  EP’s  must  demonstrate  barriers  faced  to  obtaining  infrastructure  – Lack  of  broadband  

New  Eligible  Professionals  

•  New  EP’s  granted  a  2  year  limited  excep-on  •  New  EP’s  that  start  prac-cing  in  2015  would  be  granted  excep-on  un-l  2017  

Unforeseen  Circumstances  

•  Natural  disaster  •  Other  unforeseen  circumstances  

Prac-ce  at  Mul-ple  Loca-ons  

– Lack  of  control  over  availability  of  CEHRT  of  more  than  50%  pa-ent  encounters  

Pa-ent  Interac-on  

•  Lack  of  face  to  face  interac-on  with  pa-ents  •  Lack  of  follow  up  needs  with  pa-ents  

EHR  Vendor  Issues  

•  Vendor  unable  to  obtain  CEHRT  cer-fica-on  2014  

•  EP  unable  to  implement  MU  due  to  cer-fica-on  delays  from  vendor  

Exemp-on  

•  Special-es  classified  in  the  Medicare  Provider  enrollment  Chain  and  Ownership  System  (PECOS)  with  specialty  codes  – Diagnos-c  Radiology  – Nuclear  Medicine  –  Interven-onal  Radiology  – Anesthesiology  – Pathology  

Exemp-on  

•  EP’s  enrolling  in  a  new  Medicare  program  •  Hospital  based  EP’s  for  2012  or  2013  –  If  90%  or  more  of  covered  professional  services  in  and  inpa-ent  facility  or  emergency  department  

Applica-on  

•  Applica-ons  must  be  completed  and  signed  electronically  by  July  1,  2014  

•  Along  with  applica-on  proof  of  hardship  is  also  required  •  If  applica-on  is  approved  it  is  valid  for  1  payment  year  only  •  If  EP  is  claiming  excep-on  for  the  following  year  a  new  

applica-ons  must  be  submi[ed  •  Access  the  applica-on  on  the  CMS  website  for  addi-onal  

informa-on  at:    h[p://www.cms.gov/Regula-ons-­‐and-­‐Guidance/Legisla-on/EHRIncen-vePrograms/Downloads/HardshipExcep-on_EP_Applica-on.pdf    

Mul-ple  NPI’s  Applica-on  

•  A  physician  that  has  mul-ple  NPI’s  will  need  to  complete  a  separate  applica-on  

•  Mul-ple  NPI’s  applica-on  can  be  accessed  at:  h[p://www.cms.gov/Regula-ons-­‐and-­‐Guidance/Legisla-on/EHRIncen-vePrograms/Downloads/HardshipExcep-on_EP_Applica-on_Mul-pleNPIs.pdf    

Q&A  dan.holleran@quirkhealthcare.com  

aaron.rucker@quirkhealthcare.com