Find Out if 2016 Exclusions and Alternate Exclusions Apply to You

National Health IT Week is September 26-30, 2016. CMS is sharing guidance throughout the week to help providers and industry members participate successfully in ongoing CMS health IT initiatives. Stay tuned all week for the latest news and updates from CMS.

To participate successfully in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs in 2016, providers must meet the thresholds of all required objectives and measures, or qualify for an exclusion and/or alternate exclusion. Providers who meet the qualifications for an exclusion and/or alternate exclusion will not need to report on that specific objective or measure.

Exclusions

Exclusions exempt you from having to meet specific objectives. If you meet the qualifications for an exclusion, then you will not have to report on that objective and will avoid a payment adjustment in future years.

  • Exclusions are not based on specialty.
  • Specialists must evaluate whether or not they meet the exclusion criteria for each objective.
  • There is no blanket exclusion for any type of eligible professional (EP).

Alternate Exclusions

The final rule released in October 2015 – which outlined requirements for the EHR Incentive Programs in 2015-2017 (Modified Stage 2) and Stage 3 in 2018 and beyond— included additional exclusions known as “alternate exclusions” for certain objectives and measures in 2015 and 2016.

These alternate exclusions are intended to assist providers in the early stages of meaningful use by:

  • Allowing providers to use a lower threshold for certain measures, or to exclude certain measures for which there is no Stage 1 equivalent;
  • Accommodating changes required for the transition to the Modified Stage 2 objectives and measures, especially potential changes to the implementation of certified EHR technology.

In 2016, alternate exclusions are available for the following objectives:

A. Computerized Provider Order Entry

  • Measure 2: Laboratory Orders
  • Measure 3: Radiology Orders

B. Electronic prescribing (Eligible hospitals only)

C. Public Health Reporting

  • Measure 2: Syndromic Surveillance Reporting (EPs)
  • Measure 3: Specialized Registry Reporting (EPs, and Eligible hospitals and CAHs)

Many of the alternate exclusions that were available in 2015 are not applicable in 2016.

Note: Providers may opt to use the alternate exclusions, but they are not required to use them. The registration and attestation system will automatically identify providers who are eligible for alternate exclusions.