Meaningful Use Final Rule: Alternate exclusion and hardship exception

CMS has clarified the exclusions and hardship exceptions for Meaningful Use Final Rule for 2015, 2016 and 2017.

For 2015, how should a provider report on the public health objective if they had not planned to attest to certain public health measures?

CMS does not intend to inadvertently penalize providers for their inability to meet measures that were not required under the previous stages of Meaningful Use. Nor did they intend to require providers to engage in new activities during 2015, which may not be feasible after the publication of the final rule in order to successfully demonstrate Meaningful Use in 2015.

Is there an alternate exclusion available to accommodate the changes to how the measures are counted?

In the final rule at 80 FR 62788, CMS discusses the final policy to allow for alternate exclusions and specifications for certain objectives and measures where there is not a Stage 1 measure equivalent to the Modified Stage 2 (2015, 2016 and 2017) measure or where a menu measure is now a requirement.

This includes the public health reporting objective as follows.

  • First, eligible providers (EPs) scheduled to be in Stage 1 may attest to only 1 public health measure instead of 2.

  • Second, we will allow providers to claim an alternate exclusion for a measure if they did not intend to attest to the equivalent prior menu objective consistent with our policy for other objectives and measures as described at 80 FR 62788.

What reporting objectives alternate exclusions are allowed?

CMS will allow Alternate Exclusions for the Public Health Reporting Objective in 2015 as follows:

EPs scheduled to be in Stage 1:

  • Must attest to at least 1 measure from the Public Health Reporting Objective Measures 1-3

  • May claim an Alternate Exclusion for Measure 1, Measure 2 or Measure 3.

  • An Alternate Exclusion may only be claimed for up to two measures, then the provider must either attest to or meet the exclusion requirements for the remaining measure described in 495.22 (e)(10)(i)(C).

EPs scheduled to be in Stage 2:

  • Must attest to at least 2 measures from the Public Health Reporting Objective Measures 1-3

  • May claim an Alternate Exclusion for Measure 2 or Measure 3 (Syndromic Surveillance Measure or Specialized Registry Reporting Measure)

If an EP is unable to effectively plan for a reporting period in 2015 due to the timing of the publication of the 2015 through 2017 Modifications final rule, can they apply for a hardship exception?

Yes, 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 under the “extreme and uncontrollable” circumstances category. Each hardship exception application will be reviewed on a case-by-case basis, as required by law. In the past, CMS has considered these applications seriously and, in fact, has approved over 85% of hardship exemptions. Hardship applications will be available in early 2016 on the CMS Website.

As you submit electronic claims for services, remember that:

  • Claims with ICD-10 diagnosis codes must use ICD-10 qualifiers; all claims for services on or after October 1, 2015, must use ICD-10

  • Claims with ICD-9 diagnosis codes must use ICD-9 qualifiers; only claims for services before October 1, 2015, can use ICD-9