Since 2015, the Centers for Medicare & Medicaid Services (CMS) has imposed meaningful use payment adjustment on eligible professionals not meeting the yearly requirements set for the EHR Incentive Programs.
According CMS, 171,000 EPs are facing payment penalties in 2017 for failing to meet meaningful use requirements in 2015. While still a sizeable figure, the numbers are down from years previous. In 2016, 209,000 EPs were subject to penalization leading to a 2-percent decrease in Medicare reimbursement, and in 2015 there were almost 257,000 professionals incurring these adjustments.
Though there are still a significant number of EPs affected by the meaningful use penalty, recent trends anticipate a steady decrease in issued payment adjustments going forward.
These most recent meaningful use payment adjustments will apply to Medicare Physician Fee Schedule (MPFS) payments for professional services delivered between Jan. 1, 2015, and Dec. 31, 2017.
The penalty rate operates on a rising scale year to year, capped at three percent in 2018 for meaningful use performance in 2016
According to a recent BNA Health Care Daily Report, “The program's penalty phase, which began in 2015, levies a 1 percent reduction in Medicare reimbursements each year that a provider doesn't successfully participate. Providers who faced a 1 percent penalty in 2015 and again failed to meet the program's requirements face a 2 percent penalty in 2016, likely accounting for the increase in total penalties despite fewer providers facing penalties.”
To qualify for the Medicare incentive payment program, eligible professionals must have enrolled by 2012. EPs who demonstrated standard meaningful use practices can receive up to $43,720 in incentive payments over five years.
However, as of 2015, any eligible professionals who did not fulfill meaningful use requirements were penalized by downward adjustment to MPFS payments. If these providers had also failed to meet the requirements of the now-defunct Electronic Prescribing Incentive Program, they faced a two-percent reduction in Medicare reimbursement. Otherwise, eligible professionals subject to meaningful use payment adjustments saw a one-percent decrease in Medicare reimbursement.
There are ways to avoid a payment adjustment even after failing to demonstrate meaningful use in either the Medicaid EHR Incentive Program or the Medicaid EHR Incentive Program.
For example, an EP can apply for a meaningful use hardship exception. These exceptions are in place to grant flexibility to EPs on a case-by-case basis if CMS rules that compliance with outlined meaningful use standards would cause significant hardship.
Significant hardship, as defined by the EHR Incentive Program Payment Adjustment Fact Sheet, includes special cases ranging from challenges with infrastructure that inhibits eligible professionals from having internet access to issues with extreme and uncontrollable circumstances, such as a natural disaster, that may bar eligible providers from meeting all meaningful use requirements.
Additionally, eligible professionals can submit reconsideration forms to address any potential errors in data entry or reporting that may have led CMS to assess meaningful use payment adjustments. The deadline for submitting these forms for the 2017 Medicare payment adjustment is Feb. 28, 2017.
While these payment adjustments may irk many eligible professionals, there is a light at the end of the tunnel. As CMS phases out EHR Incentive Programs in favor of the Merit-Based Incentive Payment System (MIPS) part of MACRA implementation, Medicare EPs will no longer be obligated to demonstrate meaningful use as such.
Instead, they will be subject to Quality Payment Program’s budget-neutral payment adjustment system. Participation of the Quality Payment Program began at the start of 2017 and payment adjustments go into effect as of 2019 and apply to eligible clinician performance this year.