Posts Tagged ‘ep’

Hardship Exemptions for Medicare E-Prescribing Penalty

Posted on: June 18th, 2012 by admin No Comments

The Center for Medicare & Medicaid Services (CMS) implemented the Electronic Prescribing (eprescribing) Incentive Program in 2009. This goal of this program is to encourage more providers to start eprescribing. It uses incentive payments (bonuses) and payment adjustments (penalties) to encourage the use of eprescribing.

There is a penalty for providers who do not eprescribe in 2012, as well as 2013 and 2014. This penalty will increase every year, such that the penalty will be 1.0% in 2012, 1.5% in 2013, and 2.0% in 2014.

Exclusion Criteria

According to CMS, the 2013 eprescribing penalty only applies to certain individual eligible professionals. CMS will automatically exclude those individual eligible professionals who meet the following criteria:

  • The eligible professional is a successful electronic prescriber during the 2011 eprescribing 12- month reporting period (January 1, 2011 through December 31, 2011).
  • The eligible professional is not an MD, DO, podiatrist, Nurse Practitioner, or Physician Assistant by June 30, 2012, based on primary taxonomy code in the National Plan and Provider Enumeration System (NPPES).
  • The eligible professional does not have at least 100 Medicare Physician Fee Schedule (MPFS) cases containing an encounter code in the measure’s denominator for dates of service from January 1, 2012 through June 30, 2012.
  • The eligible professional does not have 10% or more of their MPFS allowable charges (per TIN) for encounter codes in the measure’s denominator for dates of service from January 1, 2012 through June 30, 2012.
  • The eligible professional does not have prescribing privileges and reported G8644 on a billable Medicare Part B service at least once on a claim between January 1, 2012 and June 30, 2012.

Avoiding the 2013 eRx Payment Adjustment

Individual eligible professionals who were not successful electronic prescribers in 2011 can avoid the 2013 eprescribing penalty by meeting the specified reporting requirements between January 1 and June 30, 2012.

6-month Reporting Requirements to Avoid the 2013 eprescribing penalty:

  • Individual Eligible Professionals – 10 eRx events via claims

For more information on reporting requirements, please see the MLN Article SE1206 – 2012 Electronic Prescribing (eRx) Incentive Program: Future Payment Adjustments.

CMS may exempt individual eligible professionals from the 2013 eprescribing penalty if it is determined that compliance with the requirements for becoming a successful electronic prescriber would result in a significant hardship.

Significant Hardships

The significant hardship categories are as follows:

  • The eligible professional is unable to electronically prescribe due to local, state, or federal law, or regulation
  • The eligible professional has or will prescribe fewer than 100 prescriptions during a 6-month reporting period (January 1 through June 30, 2012)
  • The eligible professional practices in a rural area without sufficient high-speed Internet access (G8642)
  • The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing (G8643)

Submitting a Significant Hardship Code or Request

To request a significant hardship, individual eligible professionals must submit their significant hardship exemption requests through the Quality Reporting Communication Support Page on or between March 1 and June 30, 2012. Please remember that CMS will review these requests on a case-by-case basis. All decisions on significant hardship exemption requests will be final.

Significant hardships associated with a G-code may be submitted via the above link or on at least one claim during the 2013 eprescribing reporting period (January 1 through June 30, 2012). If submitting a significant hardship G-code via claims, it is not necessary to request the same hardship through the link above.

For more information please see the below links:

For additional information and resources, please visit the website for the E-Prescribing Incentive Program.

(Most of the information in this post is taken directly from CMS)