The Centers for Medicare and Medicaid Services (CMS) recently finalized changes to the Medicare Electronic Prescribing (eRx) Incentive Program for Calendar Year 2011. Since the onset of the e-Prescribing Incentive Program, the AOA has called on CMS to revise the program, particularly as it relates to payment adjustments.
Fee Schedule
Payment adjustments will apply beginning in January 2012 for eligible professionals who are not successful electronic prescribers. The fee schedule amount for covered professional services furnished by eligible professionals who are not recognized as successful electronic prescribers shall be 1% less than the fee schedule amount that would otherwise apply. Reductions for future years are 1.5% in 2013 and 2.0% in 2014 and beyond.
Physician practices and other providers can avoid the payment adjustment if they are successful e-prescribers or if they meet certain criteria or exemptions.
New Exemptions
Under the final rule, a qualified electronic prescribing system is one that performs certain functions or uses Certified EHR Technology. This change goes into effect as of Oct. 6, 2011, and does not apply retrospectively. In addition, CMS expanded the exemptions, which will be determined on a case-by-case basis. Physician practices can request the following new exemptions:
Participate in the Medicare or Medicaid EHR Incentive Programs and adopt certified EHR technology. All requirements to qualify for this exemption must be met by Oct. 1, 2011, and prior to the time the exemption is requested. A physician or group practice must have Certified EHR Technology available for immediate use.
Unable to electronically prescribe due to local, state, or federal law or regulation; i.e., physicians who mainly prescribe narcotics, but due to limitations in laws or regulation, cannot submit these prescriptions electronically.
Limited prescribing activity; i.e., practices that have prescribing privileges, but do not prescribe or very infrequently prescribe, yet still meet the threshold for the payment adjustment to apply.
Insufficient opportunities to report the electronic prescribing measure; i.e., practices may meet the 10% threshold for applying the payment adjustment and have at least 100 denominator-eligible visits, but the bulk of their prescribing activity occurs in other circumstances that are not accounted for by the measure’s denominator.
Applying for Exemptions
Practices have until Nov. 1, 2011, to request an exemption via a Web-based tool for individual eligible professionals and via a mailed letter for group practices that are participating in the 2011 eRx group practice reporting option. The following information must be included in the request:
Identifying information which include the TIN, NPI, name, mailing address, and email address of all affected eligible professionals.
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 or group practice (as was previously described).
An attestation of the accuracy of the information provided.
Other Criteria and Exemptions
The eligible professional is not a physician (DO, MD, or podiatrist), nurse practitioner, or physician assistant as of June 30, 2011, and does not generally have prescribing privileges, and reports G8644 (not having prescribing privileges) at least one time on an eligible claim prior to June 30, 2011;
The eligible professional does not have at least 100 cases containing an encounter code in the electronic prescribing measure’s denominator;
The eligible professional’s allowed charges for covered professional services submitted for the electronic prescribing measure’s denominator codes is less than 10% of the eligible professional’s total 2011 Medicare Part B PFS allowed charges;
The eligible professional reports a significant hardship code and CMS determines that the hardship code applies and is granted an exemption; OR
The eligible professional becomes a successful electronic prescriber for purposes of the 2012 payment adjustment by reporting the electronic prescribing measure via claims for at least 10 unique electronic prescribing events for patients in the denominator of the measure between Jan. 1, 2011 and June 30, 2011.
Hardship Exemption Codes for 2012 Payment Adjustment
G8642 - The eligible professional practices in a rural area without sufficient high speed internet access
G8643 - The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing