The eRx Hardship Exemption:
Who Can Submit the Request?
By Justin Vaughn, M.Div, CPC

10/4/2011

As you know from our previous alerts, providers who fail this year to successfully participate in the E-prescribing (eRx) Incentive Program have certain options available to avoid the financial penalty scheduled for 2012.  Among these options are 2 previous, as well as 4 new, “hardship exemptions.”  However, to be considered for one of these 6 exemptions, one must request it by November 1. 

It had been thought that it would be possible for ancillary staff, such as billing agents or practice administrators, to undertake the filing of such a request on behalf of the provider.  However, an FAQ published recently by CMS has dashed such hopes.  The relevant portion of the FAQ reads as follows:

Q:  Can I submit a significant electronic prescribing (eRx) hardship exemption request on behalf of a provider in my office? 

A:  No, you may not. Billing managers, office managers, receptionists, and other office staff cannot submit an eRx hardship exemption request on behalf of their eligible professionals for the 2012 eRx payment adjustment.  The Tax Identification Number/National Provider Identifier (TIN/NPI) requesting the significant hardship exemption must be the one who enters the request by November 1, 2011.

Accordingly, if you intend to seek a hardship exemption, you will personally need to follow the steps outlined in the most recent version of the final rule for the eRx Incentive Program.  That rule, in pertinent part, states:

Specifically, to request a significant hardship exemption . . . an eligible professional . . .  [must] provide to us, via a Web-based tool . . . (or by mail, if it is not technically feasible . . .) the following:

• Identifying information such as the TIN, NPI, name, mailing address, and e-mail address of [the] affected eligible [professional].

• The significant hardship exemption category(ies) . . . that apply.

• A justification statement describing how compliance with the requirement for being a successful electronic prescriber for the 2012 eRx payment adjustment during the reporting period would result in a significant hardship to the eligible professional . . . . The justification statement should be specific to the category under which the eligible professional . . . is submitting its request and must explain how the exemption applies to the professional . . . . For example, if the eligible professional is requesting a significant hardship exemption due to Federal, State, or local law or regulation, he or she must cite the applicable law and how the law restricts the eligible professional's ability to electronically prescribe. Similarly, if the eligible professional is requesting a significant hardship due to lack of prescribing activity, the eligible professional must provide the number of prescriptions generated during the 2012 eRx payment adjustment reporting period.

• An attestation of the accuracy of the information provided.

Due to the lack of perfect clarity in several sections of the final rule that deal with how exemption requests must be submitted, I can only assert that CMS intends that individual providers use the web-based tool to submit their request.  (However, there may be an exception to this requirement if it is not technologically feasible for the provider to use the web-based tool.  In such a case, the implication is that the provider may submit the request by U.S. mail—which must be postmarked by November 1, 2011.  In no case can requests be submitted via email or fax.  Due to the gray language found on this point, I strongly urge you to submit your exemption request only through the web-based tool if at all possible.)  To access the web-based tool, a recent CMS FAQ has stated:

Submission will be completed using a new CMS provider website, called the Quality Reporting Communication Support Page. It will be available at http://www.qualitynet.org/pqrs, so please continue checking the website for updates and additional information. The Quality Reporting Communication Support Page is where the eligible professional will be instructed to enter the hardship exemption request and supporting rationale.

Providers interested in additional information on the eRx program should continue to monitor the CMS eRx website at https://www.cms.gov/ERxIncentive for more information, or contact your Medac compliance representative.

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.