Anesthesia Coding Alert

Good news: Anesthesiologists can still qualify for some exemptions.

The final rule on stage 3 of CMS’s Electronic Health Record Incentive Program and modifications to meaningful use (MU) was released in early October, and the news is good for anesthesia providers. Physicians designated as anesthesiologists (specialty 05) in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) six months before the first day of payment adjustments for the year have an automatic exemption and do not need to apply to avoid the penalty. The final rule explicitly affirms the availability of the PECOS specialty exception, subject to annual renewal.

Refresher: The American Recovery and Reinvestment Act of 2009 established the Electronic Health Record (EHR) Incentive Program. Separate Medicare and Medicaid programs provide for incentive payments to eligible professionals (EPs) who are meaningful users of certified EHR technology. The last year in which EPs could earn a Medicare incentive payment was 2014; the Medicaid program provides for incentives through 2016. Starting on Jan. 1, 2015, EPs who do not demonstrate MU under either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program are subject to a payment “adjustment” or penalty—unless they fall into an exception category. The penalty for not demonstrating MU in 2015 is one percent of the EP’s fee schedule payments. It will grow to two percent in 2016 and to three percent in 2017 and 2018.

Also of interest: The rule also includes an exemption for hospital-based eligible professionals (those who provide 90 percent or more of their covered services in a hospital inpatient or emergency room setting). CMS determines this classification based on the place of service codes on claims submitted to Medicare (POS code 21 for Inpatient Hospital and POS code 23 for Emergency Room - Hospital).

“Most anesthesiologists perform the bulk of their services in the Outpatient Hospital (POS code 22) or Ambulatory Surgical Center (POS code 24) rather than in an inpatient setting,” Tony Mira of Anesthesia Business Consultants in Jackson, Mi., states in a recent blog post. “The exemption is not applicable to these anesthesiologists, but they can rely on the PECOS specialty exemption.”

Non-anesthesiologist physicians (such as pain specialists) who will not be able to demonstrate MU in 2015 may apply for a hardship exception under the “extreme and uncontrollable” circumstances category. Those circumstances would likely include the inability to satisfy the EHR Incentive Program conditions because the Final Rule was not released until after the start of the last 90-day reporting period, according to a FAQ published on Oct. 7. In the FAQ, CMS also stated that, “In the past, CMS has considered these applications seriously and, in fact, has approved over 85% of hardship exemptions.”

For those physicians who do not qualify for any of the exemptions, the Final Rule relaxes the MU requirements for Stage 2 as modified and Stage 3 in a number of respects. One area of interest to all providers is the establishment of a single set of objectives and measures that all EPs will be required to attest in 2015 and 2016. This replaces the core and menu structure of Stage 1 and the earlier version of Stage 2. In addition, the number of required objectives has been reduced from 18 to 10, including one consolidated public health reporting objective.

Input: CMS will be accepting “comments” on the Final Rule for 60 days, through Dec. 15, 2015. The Agency is looking for feedback on the EHR Incentive program itself, and on how best to incorporate it into payment framework established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).