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Your top meaningful use questions: Are non-par and hospital-based providers exempt from penalties?

Last Updated: 01 June 2015

As the Medicare EHR Incentive (meaningful use) Program shifts away from incentives and moves into a penalty phase, it is critical that physician group practices understand how they may be impacted. Some of the most frequently-asked MGMA member questions about the meaningful use penalty include:

Q: Are providers who elect not to participate with Medicare exempt from meaningful use penalties? 

A: No. Eligible professionals (EPs) are not exempt from meaningful use penalties based solely on their non-participation status in Medicare. However, as the penalty is applied to Medicare payments, those who do not submit claims to Medicare will not incur any penalty, regardless of their Medicare participation status. Members are also reminded that there are no penalties associated with the Medicaid EHR Incentive Program.

Q: Do hospital-based EPs have to apply for a hardship exception in order to avoid the meaningful use penalty?

A: No. EPs who perform substantially all of their services in an inpatient setting are exempt from the penalty, and the Centers for Medicare & Medicaid Services (CMS) will automatically make this determination based on place of service data pulled from Medicare claims. Specifically, EPs who performed 90% or more of their covered professional services in either an inpatient or emergency department are exempt and do not need to apply for a hardship exception. However, CMS has stated it may look at claims data from either 2014 or 2015 to determine whether an EP is hospital-based for the 2016 penalty.