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Washington Debrief: More Details Emerge on MU Hardship Exemptions

March 17, 2014
by Jeff Smith, Senior Director of Federal Affairs
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Jeff Smith, Senior Director of Federal Affairs

Details Emerge on Meaningful Use Hardship Exceptions; More Details Needed, CHIME Says

Key Takeaway: The Centers for Medicare and Medicaid Services (CMS) updated guidance and applications for Electronic Health Record (EHR) Incentive Payment hardship exceptions this week to include “2014 Vendor Issues,” related to meaningful use (MU) in 2014.

Why it Matters: CIOs who are on the brink of being “Meaningful Use-ready” by July 1 should examine the new EHR hardship exception application to see if they qualify. However, CIOs should know that if they do not meet MU requirements in 2014, but are successful in obtaining a hardship exception, they will lose all incentives due to their organization for program year 2014.

What’s Next: Another round of hardship exception revisions is expected later this year. It is unclear if those revisions will enable providers to avoid reimbursement penalties.

The dominos have been slow to drop, but they are dropping nonetheless. It began with a sign-on letter to the Department of Health and Human Services (HHS) from nearly 50 provider stakeholder groups asking for relief on Meaningful Use timelines and program requirements. Then came the announcement made by CMS Administrator Marilyn Tavenner, assuring HIMSS14 audiences that policymakers “are listening” and that “relief is coming.” Last week, that relief materialized in the form of a new EHR hardship exception category, called “2014 Vendor Issues.” According to updated guidance, EHs, EPs and CAHs who are “unable to implement EHR Technology certified to the 2014 edition certification criteria in time to successfully demonstrate meaningful use for the 2014 reporting year…may be eligible for a hardship exception from the applicable Medicare payment adjustments.” Specifically, the hardship exception application contains two options for providers to check:

  1. Vendor unable to obtain 2014 certification
  2. Provider unable to implement meaningful use due to 2014 EHR certification delays

In media interviews, CHIME officials said the expanded category was a “step in the right direction,” but that more information is needed to ensure that good-faith efforts are not penalized. Upon receiving word that CMS intends to publish more revisions for providers looking for relief during the 2014 program year, CHIME said, “Should CMS choose to define the new hardship exceptions in a way that does not address the core concerns of our industry we will continue to seek the kind of flexibility that nearly 50 national healthcare organizations communicated to HHS Secretary Kathleen Sebelius on February 21, 2014.”

Stage 3 MU Milestone Reached, Recommendations Approved by HIT Policy Committee

Key Takeaway: The Health IT Policy Committee last week voted to approve recommendations for Stage 3 Meaningful Use.

Why it Matters: While somewhat pared down from draft recommendations, Stage 3 will largely build off Stage 2 measures and objectives. It remains to be seen what alterations CMS will make based off experience with Stage 2.

A key Meaningful Use milestone was passed last week when members of the Health IT Policy Committed agreed on a final set of recommendations for Stage 3. The next phase of Meaningful Use is due to start in 2017 and HITPC members put forth recommendations for 19 objectives, which is similar to the number of objectives for previous Stages. The HITPC recommendations put emphasis on objectives that will further interoperability and enhance care coordination. The objectives also look to build off clinical decision support, patient engagement and population management trends seen throughout the healthcare industry. According to HITPC work materials, the final recommendations dropped eight areas previously recommended by the Meaningful Use Workgroup, including objectives related to eMAR, syndromic surveillance for EPs, imaging and family history.

CMS is expected to publish a notice of proposed rulemaking for Stage 3 in the fall of 2014.

CMS Announces ICD-10 Testing Plans

Key Takeaway: CMS announced details for ICD-10 end-to-end testing, which will occur during the week of July 21 through July 25. CMS is hoping to have 500 volunteers submit claims containing 1CD-10 codes.

Why it Matters: CMS had originally dismissed calls to conduct end-to-end testing for ICD-10. CIOs interested in helping CMS ensure a smooth rollout of ICD-10 should contact their Medicare Administrative Contractor to file a volunteer form. All forms must be complete by March 24 to be considered.

CMS last week detailed how it intends to conduct end-to-end testing for ICD-10. According to an announcement, CMS is looking for roughly 500 volunteers, including “a broad cross-section of provider, claim and submitter types, including claims clearinghouses, which represent large numbers of providers.” The goal of this testing is to demonstrate that:

  • Providers and submitters are able to successfully submit claims containing ICD-10 codes to the Medicare Fee-For Service (FFS) claims systems
  • CMS software changes made to support ICD-10 result in appropriately adjudicated claims
  • Accurate Remittance Advices are produced using 2014 payment rates

CMS will choose more than a dozen MACs to perform the testing, who will then select 32 volunteers to participate in the testing. At least five of the selected organizations, but no more than 10, must be clearinghouses.

Selected testing volunteers will be notified by April 14, CMS said.

CHIME Public Policy Webinar with ONC’s Steve Posnack

Policy Innovation or Policy Overkill – A Look at ONC’s EHR Certification Roadmap (1 CEU)

Friday, March 21, 2014/ 2:00 PM ET

ONC recently released proposed rules for voluntary 2015 Edition EHR certification criteria. The new rule is a shift in ONC’s regulatory approach to a more incremental and frequent publication schedule that is meant to benefit the industry and enable better policymaking. It represents ONC’s first attempt to publish updates apart from CMS rules for Meaningful Use and it foreshadows how ONC views their role in a post-Meaningful Use world.

ONC’s Director of Federal Policy Steve Posnack will join CHIME policy leaders to discuss the proposed rule, why officials believe it’s important to produce more regular updates, and how providers might benefit from the voluntary 2015 Edition EHR certification criteria.

Register Now


The Health IT Summits gather 250+ healthcare leaders in cities across the U.S. to present important new insights, collaborate on ideas, and to have a little fun - Find a Summit Near You!


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