2012 eRx Deadline Approaches
By Justin Vaughn, M.Div, CPC
Director of Compliance

5/31/2012

As a final reminder to our chronic pain physicians, June 30, 2012 is a key date in the Medicare E-Prescribing (eRx) Incentive Program.  It acts as a dual deadline for avoiding the 1.5% reduction in your total Medicare allowable payment for 2013, since by this date you must have either:

• Successfully reported at least 10 eRx events on applicable Medicare claims (via G-code G8553); or

• Submitted a hardship exemption request, if applicable.

Again, you are not subject to the 2013 eRx penalty if your Medicare allowable for office/outpatient E/M services (codes 99201-99215) accounts for less than 10% of your TOTAL Medicare allowable for DOS Jan 1-Jun 30, 2012.  If such is the case, then you would not have to submit any eRx, G-code or hardship request to avoid the 2013 penalty.  Your exemption from the penalty is automatic.  The problem is that you won’t officially know whether you’ve met the 10% threshold until later this year when the official CMS calculation is conducted, making it difficult to determine where you stand by the June 30 deadline. 

If you believe that you will be eligible for the program (and penalty), and you have a certified eRx system in place, make sure that you have submitted to Medac at least 10 Medicare cases where at least 1 eRx was submitted and documented (DOS Jan 1-Jun 30, 2012), so that our coders can ensure the claims are correctly identified and processed.  If you do not have such a system, and you believe you will be deemed eligible for the program (based on the 10% E/M threshold discussed above), then you can attempt to avoid the 2013 penalty by filing a hardship exemption by the aforementioned deadline.

If you need more information on avoiding the 2013 eRx penalty, please visit the following CMS link.  To submit a hardship exemption, go to the following link. 

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in the health care regulatory and compliance environments, the author's presentation of this information might become outdated.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.