IPPS Measure Exceptions Form Centers for Medicare & Medicaid Services (CMS) Hospital Inpatient Quality Reporting (IQR) Program Hospital Associated Infection (HAI) Exception Form. Hospital Associated Infection (HAI) Exception Form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the required fields marked with an asterisk (*). Start with the 'IPPS Measure Exception Information' section, selecting all applicable measures such as Perinatal Care, Emergency Department, and Healthcare-Associated Infection.
3. Specify the applicable quarter(s) for your Measure Exception request. Ensure you enter the correct Calendar Year (YYYY) and select the relevant time frame.
4. Complete the 'Facility Contact Information' section by entering your CMS Certification Number, Facility Name, and CEO/Designee details including their name, title, email address, and telephone number.
5. Certify that your facility meets the exception criteria by signing your name and providing your position before submitting the form.
6. Submit the completed form via email to QRSupport@hcqis.org or through secure fax or QualityNet Secure Portal as instructed.

Start using our platform today to streamline your form completion process for free!