Hardship Exception Application Forms for 2018 Payment Adjustment Now Available on EHR Incentive Programs Website

June 30, 2017

Payment adjustments for Medicare eligible professionals (EPs) and eligible hospitals that did not meet meaningful use in 2016 will be applied beginning on January 1, 2018.

EPs and eligible hospitals can take action by submitting a 2018 hardship exception application by July 1, 2017. The application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2017 to be considered.

If approved, the exception is valid for the 2018 Medicare payment adjustment only. If you intend to claim a hardship exception for a subsequent payment adjustment year, a new application must be submitted for the appropriate year. In no case may a provider be granted an exception for more than five years.

EPs that do not need to submit a hardship application:

• If an EP is newly enrolled to Medicare and begins to submit Medicare claims in 2016, the EP will receive an exception to the 2018 payment adjustment and does not need to submit an application.
• If an EP is hospital-based in 2016, the EP will receive an exception to the 2018 payment adjustment and does not need to submit an application.
• If an EP is classified in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) with one of the following five specialty codes as their primary specialty, the EP will receive an exception to the 2018 payment adjustment and does not need to submit an application (Anesthesiology-05, Diagnostic Radiology-30, Interventional Radiology-94, Nuclear Medicine-36, Pathology-22).

Eligible hospitals that do not need to submit a hardship application:

• A hospital that demonstrated meaningful use successfully in 2016 will be exempt from the payment adjustment and does not need to submit an application. If the hospital is new AND obtained a new CMS Certification Number (CCN) during 10/01/2015 through 07/01/2017, it does not need to submit an application. The hospital will be granted a Hardship Exception and are automatically exempt from the 2018 payment adjustment based on the data in PECOS.

For More Information

The hardship exception applications and instruction documents for EPs and eligible hospitals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use.