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You have only a few more days to avoid Medicare e-Rx penalty
e-Reports, Oct. 24, 2011
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You’re just about out of time to avoid 2012 Medicare fee adjustments for failing to participate in the Centers for Medicare & Medicaid Services (CMS) Electronic Prescribing (eRx) Incentive Program. However, you do have time to claim a hardship waiver.

In 2009, CMS implemented the eRx program, which uses incentives and payment adjustments to encourage use of electronic prescribing systems. Incentives are based on claims electronically submitted for at least 10 patients who received electronic prescriptions between Jan. 1 and June 30, 2011. To earn the 1 percent bonus, you must send a minimum 25 e-prescriptions between Jan. 1 and Dec. 31, 2011.

That’s the carrot, but a stick will follow. Beginning in 2012 through 2014, annual graduated payment adjustments will be applied to your covered professional services under the Medicare Part B Physician Fee Schedule for not prescribing electronically.

Payment adjustments in 2012 will be 1 percent, but expect increased penalties after that. By sending the 25 e-prescriptions before Dec. 31, you will avoid penalties in 2013.

Act NOW before Nov. 1
To avoid the eRx payment adjustment, you have only until Nov. 1 to either become a successful electronic prescriber or report to CMS that:

  • You were not a physician (M.D., D.O. or podiatrist), nurse practitioner or physician assistant as of June 30, 2011, based on primary taxonomy code in NPPES.
  • You did not have prescribing privileges and reported G8644 at least one time on a claim before June 30, 2011.
  • You did not have at least 100 patient visits coded in the measure’s denominator (CPT codes).
  • You can qualify for a hardship exemption because:
    • Your practice is located in a rural area with limited high-speed Internet access.
    • Your practice is located in an area with limited available pharmacies for electronic prescribing.

And NEW in September, you may qualify for an exemption if you are an eligible professional who:

  • Has adopted certified EHR technology and are registered to participate in the 2011 Medicare or Medicaid EHR Incentive Program
  • Is unable to electronically prescribe due to local, state or federal law or regulation
  • Has limited prescribing activity
  • Has insufficient opportunities to report e-Rx measures because of limitations in the measure’s denominators

Individual physicians can make hardship exemption requests through the Quality Communications Support Page at www.ismanet.org/go/Qnet. However, group practices must apply for the waiver in writing to CMS with postmark no later than Nov. 1.

Send to:

Significant Hardship Exemptions
Centers for Medicare & Medicaid Services
Office of Clinical Standards and Quality
Quality Measurement and Health Assessment Group
7500 Security Blvd., Mail Stop S3-02-01
Baltimore, MD 21244-1850

Learn more about the 2012 e-Rx payment adjustment here.

Read about recent changes to the CMS e-Rx program on the CMS website.

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