Freed Associates

Avoid Meaningful Use Penalties: Check Your Hospital-based Status

TOPIC: Meaningful Use

Do you have providers in your organization who have crossed from being exempt from Meaningful Use (MU) requirements to being subject to meeting them—and are subject to penalties if they do not? The Centers for Medicare and Medicaid Services (CMS) defines a provider as hospital-based if 90% or more of his or her services are provided in an inpatient or emergency department setting.

Some providers work primarily in a hospital setting, such as emergency department (ED) physicians or Hospitalists, and also work infrequently in a hospital outpatient department, urgent care clinic, or a skilled nursing facility. These providers may not realize they have fallen below the 90% threshold and are, in fact, eligible for (and subject to) MU. We consider these providers to be “semi-hospital-based Eligible Professionals (EPs).”

Prior to 2014, the only negative implication for these semi-hospital-based EPs was that they were not receiving incentive payments. 2014 brings a hard deadline to successfully attest or be subject to increasing payment penalties; it is no longer about not receiving an incentive.

The regulations state that anyone who works primarily in an outpatient setting is eligible to apply for the EHR Incentive Program if over 10% of their practice is ambulatory. EPs must demonstrate they are meaningful users of Stage 1 Year 1 criteria for a minimum of a 90-day period by October 1, 2014, or apply for a hardship exemption, in order to avoid a 1% Medicare payment penalty beginning January 1, 2015.

CMS determines if an EP is considered hospital-based by looking at claims billed from the CMS fiscal year, which runs from October – September, prior to the payment year. This means their hospital status for 2014 will be determined on claims data from October 2012 – September 2013. The hospital-based status of an EP is reassessed each year, so EPs who were previously deemed hospital-based should double-check their status for 2014.

Providers can check their hospital-based status by registering for the EHR Incentive Program and checking under the “Status” tab. Providers will need an Identity and Access account in order to register for the EHR Incentive Program and can register for an account here.

Providers who already checked their hospital-based status in a prior year will likely need to call CMS to reconfirm their status for the current year because the status screen does not automatically update.

EPs can use any consecutive 90-day reporting period in 2014 and must attest by 10/1/2014 11:59 PM ET. For more information on the Meaningful Use program requirements and deadlines, visit the CMS EHR Incentive program website.