E-Prescribing Exemption Deadline Approaching
By Justin Vaughn, M.Div, CPC
Director of Compliance

10/26/2011

This is a reminder for those of you who are deemed eligible for participation in CMS’s E-Prescribing (eRx) Incentive Program that you have until Nov 1 to file for an exemption from the penalty for unsuccessful participation (1% reduction in your Medicare allowable), to be imposed in 2012.  You do not have to file for an exemption if even one of the following criteria is/has been met:

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

• Provider does not have prescribing privileges (as indicated by submitting applicable G-code by June 30, 2011).

• Provider did not submit at least 100 cases containing an encounter code in the electronic prescribing measure’s denominator (= outpatient E/M codes) from Jan 1 to June 30, 2011.

• Provider’s allowed charges for services submitted for the eRx’s denominator codes (eg, 99201?99215), from Jan 1 to June 30, 2011, are less than 10 percent of the provider’s total 2011 Medicare Part B allowed charges for that period.

• Provider successfully submitted claims indicating eRx in 10 separate denominator-applicable cases by June 30, 2011.

• Provider indicated via G-code on claim before June 30, 2011 Hardship Exemption #1: Practice is located in a rural area with insufficient high?speed internet access.

• Provider indicated via G-code on claim before June 30, 2011 Hardship Exemption #2: Lack of local pharmacies capable of receiving/processing electronic prescriptions.

If none of the above criteria applies, and you believe you will be eligible for the 2012 penalty, you can either (a) successfully submit 25 claims showing eRx by Dec 31, 2011 (this earns you a 1% bonus, which offsets the 1% penalty), or (b) you can file for 1 of 6 total hardship exemptions by Nov 1, 2011.  These exemptions are as follows:

Practice is located in a rural area with insufficient high?speed internet access.

• Lack of local pharmacies capable of receiving/processing electronic prescriptions.

• 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.”

The individual provider who believes, based on the above, that filing a request for an exemption is the only way to avoid the 2012 penalty will have to do so personally.  No third-party can do it on the provider’s behalf.  The provider must file for an exemption by going to the below website and following the instructions.  Each exemption request will be considered on a case-by-case basis.        https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234

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.