Avoiding the E-Prescribing Penalty Just Got Easier
By: Justin Vaughn, M.Div, CPC
Director of Compliance

9/1/2011

Well, sort of. CMS has published a final rule outlining a few additional escape routes for providers who are currently staring down the barrel of a 1% reduction in their Medicare reimbursement for 2012, as authorized by the E-Prescribing (eRx) Incentive Program.  As you know, eligible providers were to have submitted at least 10 prescriptions electronically by June 30th of this year in order to avoid the 1% penalty in CY 2012.  For those who were unable to meet this requirement, CMS had previously published a list of exemptions—any one of which would allow providers to avoid this penalty.  Those initial exemptions involve 2011 claims, and are reiterated below:
INITIAL EXEMPTIONS

Provider is not an MD, DO, podiatrist, NP or PA as June 30, 2011.

• Provider does not have prescribing privileges.

• “Hardship” exemption:  Practice is located in a rural area with insufficient high-speed internet access.

• “Hardship” exemption:  Lack of local pharmacies capable of receiving/processing electronic prescriptions.

• Provider did not submit at least 100 cases containing an encounter code in the electronic prescribing measure’s denominator (eg, 99201-99215).

• Provider’s allowed charges for services submitted for the eRx’s denominator codes (eg, 99201-99215) are less than 10 percent of the provider’s total 2011 Medicare Part B allowed charges.

During the last few months, CMS has received numerous comments from providers, practice administrators and others regarding the penalty provisions.  Based in part on this feedback, the government has added the following 2011 “hardship” exemptions—any one of which will allow you to avoid the 2012 penalty:

LATEST HARDSHIP EXEMPTIONS ADDED

Provider registers to participate in the Medicare or Medicaid EHR Incentive Programs and adopts certified EHR technology.

• Provider is unable to electronically prescribe due to local, state, or federal law or regulation.

• There is “limited prescribing activity.”

• There are “insufficient opportunities to report the electronic prescribing measure.”

To request an exemption based on the two initial hardship conditions or any of the newly added hardship conditions listed above, providers may now use a web-based tool and have until Nov 1 of this year to make such a request.  Instructions on how to request a hardship via the web-based tool will be available on the eRx Incentive Program website at http://www.cms.gov/ERXincentive/.

Finally, if you were unable to submit 10 cases indicating e-prescriptions by June 30 of this year, and find that you do not fall under one of the initial or new exemptions listed above, do not despair.  It is still possible to dodge the 1% payment reduction in 2012.  All you must do is secure a government-approved eRx system, and submit at least 25 Medicare cases involving eRx before December 31, 2011.  Doing so will earn you the 1% bonus, thereby offsetting the 1% payment reduction!

I know this is frustrating, complicated, and a bit daunting.  The purpose of these alerts is to give you a “heads up,” and point you in the right direction.  However, we recommend that you review the government’s eRx website (listed above) for yourself if you are contemplating participation in the eRx program.  There are innumerable resources available on this site, and you will certainly want to familiarize yourself with the full range of facts before moving forward.  In addition, your compliance contact at Medac will continue to be available if you have specific questions regarding this program.

The information presented herein reflects general information that is current as of the date it was first published.  In light of changes that may occur in the health care regulatory and compliance environments, the author's presentation of this information might become outdated.  Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.