New Meaningful Use Guidance Clarifies the Radiology Hardship Exception

Many of the requirements for qualifying for the Centers for Medicare and Medicaid Services (CMS) electronic health record (EHR) meaningful use incentive payments are difficult to meet if you do not have regular face-to-face interactions with your patients. This is often the case for radiologists, pathologists and anesthesiology. Recognizing this, CMS included in the Stage 2 meaningful use regulations an optional significant hardship exception that would allow eligible professionals in radiology, pathology and anesthesiology to skip meeting the requirements for 5 years without penalty. Now CMS has clarified that an eligible professional in radiology is a physician in the specialty of diagnostic radiology, nuclear medicine or interventional radiology. Radiation oncologists do not qualify automatically for the five-year significant hardship exception. It seems a small matter, but by not specifying exactly which Provider Enrollment, Chain and Ownership System (PECOS) specialty codes counted as being an eligible professional in radiology in the Stage 2 final rule published last September, a confusing situation was created explained Keith J. Dreyer, DO, PhD, FACR, chair of the American College or Radiology (ACR) IT and Informatics Committee, in a statement released by the ACR. “ACR immediately brought this discrepancy to the attention of CMS, and the agency promised clarification via guidance,” Dreyer says in the statement. For the record, the Medicare Specialty Codes are diagnostic radiology (30), nuclear medicine (36), interventional radiology (94), anesthesiology (30), and pathology (22). For radiation oncologists, CMS’s guidance noted that like any eligible professional regardless of specialty, they may apply for the exception if they believe they meet the hardship exception criteria for lack of face-to-face patient contact and lack of need for follow-up care. CMS also noted in its guidance that it may need to revisit which Specialty Codes qualify for the automatic exception in future rule making because the ACR’s own guidelines say interventional radiologists should have face-to-face patient contact with each patient both before and after the procedure and that they should provide follow-up care. However, for now, interventional radiologists are included in the automatic exception. CMS has encouraged all eligible professionals to attempt to qualify for the meaningful use incentive payments, even though some do not have to under the hardship exception. Furthermore the ACR warned members that the exception is by law temporary. If you take it in calendar year 2015 to avoid CMS penalties for not meeting the meaningful use criteria, you will still face penalties come 2020, or even sooner if CMS opts to modify or remove the specialty-based significant hardship exception option. Read CMS's guidance here.