Medicare Compliance & Reimbursement

New law also toughens penalties for Medicare/Medicaid identity theft.

Although the Centers for Medicare & Medicaid Services (CMS) is clearly planning to do away with the Electronic Health Record (EHR) Incentive Program altogether, other releases from CMS seem to indicate business as usual for the program.

Good news: On Jan. 22, CMS launched a streamlined hardship application process to reduce the amount of information that participants must submit to apply for an exception. CMS released new applications and instructions for a hardship exception from the Medicare EHR Incentive Program 2017 payment adjustment.

The new streamlined process comes about from the recent passage of the Patient Access and Medicare Protection Act (PAMPA), which Congress passed on Dec. 18, 2015 and President Barak Obama signed into law on Dec. 28, 2015. In addition to providing flexibility in applying a hardship exception from Meaningful Use, PAMPA also makes changes to Medicare payments for certain complex rehabilitation technology and radiation therapy services.

Another part of the law created harsher penalties for people convicted of Medicare and/or Medicaid identity theft. Under PAMPA, individuals or corporations could face up to a $500,000 or $1 million fine respectively and up to 10 years in prison if convicted of the theft or usage of illegally obtained Medicare or Medicaid identity information, according to a Dec. 23, 2015 analysis by the Association for Medical Imaging Management (AHRA).

The new legislation established that CMS may consider hardship exceptions for “categories” of eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs) identified on CMS’s website as of Dec. 15, 2015. Before PAMPA, CMS had to review all applications on a “case-by-case basis.”

PAMPA essentially gives CMS the authority “to provide blanket exemptions to physicians who apply for hardship exemptions from Stage 2 EHR Meaningful Use penalties,” the American Osteopathic Association (AOA) explained in a Dec. 30, 2015 analysis. This means that groups of healthcare providers may apply for a hardship exception instead of each physician applying individually.

PAMPA also established and extended timelines for submitting streamlined applications, with applications from EPs due March 15, 2016, and applications from EHs and CAHs due April 1, 2016. CAHs that already submitted an exception form for 2015 do not need to resubmit.

Additionally, CMS provided Reconsideration applications for EPs (both single and multiple EPs). The deadline to submit Reconsideration forms for the 2016 payment adjustment (based on the 2014 EHR reporting period) is Feb. 29, 2016. EPs can apply for a Reconsideration only if they received a letter from Medicare indicating that they are subject to the 2016 payment adjustment.

Link: You can find the new applications and instructions for a hardship exception at www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/paymentadj_hardship.html. To read the text of PAMPA, go to www.congress.gov/bill/114th-congress/senate-bill/2425/text.