Medicare EHR Incentive Program: Penalties and Exceptions

Medicare EHR Incentive Program: Penalties and Exceptions

One of the requirements of Medicare’s Electronic Health Records Incentive Program is that Eligible Professionals (EPs) must demonstrate Meaningful Use of Certified Electronic Health Record Technology (CEHRT) by 2014 or face Medicare penalties starting in 2015.  

Penalties and Exceptions:

The American Recovery and Reinvestment Act of 2009 mandates that EPs who fail to demonstrate meaningful use of Certified Electronic Health Record Technology (CEHRT) under the Medicare EHR Incentive Program beginning in 2014 will be penalized starting in 2015. EPs who do not demonstrate they have met meaningful use will see their Medicare fee schedule amounts reduced by 1% in 2015 and up to 5% in subsequent years. For groups with less than 75% of EPs who meet meaningful use requirements, penalties go up to 5%. However, for groups who have more than 75% of their EPs meeting meaningful use, penalties only go up to 3%.

There are some EPs who may qualify for an exemption from these penalties, if they meet any of the following hardship exceptions:

1. New EPs – There is a two-year exemption for newly practicing EPs

2. Unforeseen circumstances, such as a natural disaster or bankruptcy

3. Lack of face-to-face, telemedicine interactions or lack of follow-up need/visits with patients

4. EPs who practice at multiple locations — as long as they can show a lack of control over availability of their CEHRT for more than 50% of their patient encounters

5. Infrastructure – for example, being in an area without sufficient internet access 

If you are a provider who would like to apply for a hardship exception, please check the CMS EHR Incentive Programs website for details.

Additionally, there are certain specialties that are automatically exempt from the penalties, including those who provide 90% or more of their covered services in an inpatient setting or emergency department, and providers with the following primary specialties:

Anesthesiology
Radiology
Pathology
Nuclear Medicine

Should you have any questions about CMS’s EHR Incentive Programs, please call a Risk Management Specialist at 866-815-2023.

 

Sources/Additional Resources

MGMA Washington Connexion, accessed 5/15/13

EHR Incentive Program, accessed 5/23/13

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