The 2013 E-Prescribing Penalty: A New Chance to Escape

-->October 19, 2012Billing & Compliance Alerts

    The 2013 E-Prescribing Penalty: A New Chance to Escape
    By Justin Vaughn, M.Div, CPC
    Director of Compliance


    The Centers for Medicare and Medicaid Services (CMS) announced yesterday that it will allow an extension on the filing of hardship exemptions for the purpose of avoiding the 2013 e-prescribing (eRx) penalty.  This will no doubt be deemed a positive development by many of our chronic pain providers.

    As you know, the eRx Incentive Program was designed to encourage providers to transmit prescriptions electronically, and CMS authorized modest payments to those who complied.  It also, however, mandated “financial adjustments,” i.e., payment reductions, relative to those eligible providers who failed to participate in 2012—specifically a 1.5% reduction in the provider’s total annual Medicare allowable in 2013.  For those who could not participate, hardship exemptions were made available by CMS.  Unfortunately, many pain practitioners failed to take advantage of these exemptions in time.  Yesterday’s announcement means your time has just been extended.

    Originally, eligible providers wishing to avoid the 2013 eRx penalty were to have submitted their hardship exemptions by June 30 of this year.  The new exemption filing period will run from Nov. 1, 2012 through Jan. 31, 2013.  During this period, providers seeking an exemption from program participation and the 1.5% penalty must submit their requests using the Quality Reporting Communication Support Page.  CMS also advised that the period for requesting hardship exemptions relative to the 2014 penalty—originally slated for Jan 1-Jun 30, 2013—will be reconsidered and announced at a later time.

    The main message is this:  If you would like to avoid the 2013 penalty, but failed to submit an exemption request earlier this year, you have a new lease on life beginning Nov 1. 

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in the health care regulatory and compliance environments, the author’s presentation of this information might become outdated.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