From the American Academy of Ophthalmology

July 1, 2014 is the last day to apply for Meaningful Use hardship exemption to avoid penalty in 2015. Physicians who do not successfully meet meaningful use in 2013 or complete their first 90 days of meaningful use attestation by Oct. 1, 2014 will be subject to a one percent penalty in 2015. For each subsequent year that the physician does not meet meaningful use, penalties increase by one percent.

Physicians who are not able to meet meaningful use may qualify for temporary exemptions from CMS. Eligible Professionals (EPs) who were unable to successfully achieve their second or third year of meaningful use in 2013, or EPs who are not able to achieve their first year of meaningful use in 2014 due to a qualifying hardship must apply for a hardship exemption by July 1, 2014 to avoid the 2015 penalty. Download CMS’ hardship exemption application. By law, no physician may receive an exemption for more than 5 years. Physicians will be able to apply for the following exemptions beginning in 2014:

1. Infrastructure
EPs must demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband). CMS defines insufficient access to internet as follows:

• No wired internet is available
• Internet is available, but it is cost-prohibitive due to the need to create infrastructure or has insufficient speed for meaningful use

EPs are eligible for the exemption if one of the above are true for any 90 day period in the 18 months prior to July 1 of the year prior to the payment adjustment year. EPs must submit quotes or correspondence from at least 2 internet service providers. If speed is insufficient, EPs will also need to submit supporting documents from the EHR vendor.

2. New Eligible Professionals
Newly practicing EPs who would not have had time to become meaningful users can apply for a 2-year limited exception to payment adjustments. However, they must begin the process of implementing EHR to attest by Oct. 1 of the second year.

There is no application for this exemption. CMS will determine eligibility based on Medicare claims data.

3. Unforseen Circumstances
This exemption is available for EPs who have unforeseen circumstances that prevent them from meeting meaningful use. Examples include:

• Closure
• Bankruptcy
• Other debt restructuring
• Natural disasters
• EHR loses certification

The application must specifically outline why meaningful use is unachievable.

4. Lack of face-to-face or telemedicine interaction with patients –or- lack of follow-up need with patients
Physicians who meet either exemption criteria will submit an attestation. CMS could disqualify applicants on the basis that they bill E&M codes or produce care plans that require follow-up with the patient.
Physicians whose Medicare enrollment lists diagnostic radiology, nuclear medicine, interventional radiology, anesthesiology, or pathology will automatically qualify for this exemption.

5. Lack of Control Over EHR Technology
Physicians can apply for this exemption if they meet both of the following criteria:

• Less than 50% of outpatient encounters at locations equipped with a certified EHR
• Have little or no control over whether those locations are equipped with a certified EHR

Physicians must submit an attestation that less than 50 percent of their patient encounters occur at a location equipped with a certified EHR and a copy of their agreements with the locations that do not have certified EHRs.