For the first time, practitioners who did not e-prescribe at least 10 times between Jan. 1 and June 30, 2011 or who did not meet the requirements and/or request a hardship exemption by Nov. 8, 2011 were penalized with a one percent payment reduction on all of their 2012 Medicare payments. While it is too late to avoid the 2012 penalty, there is still time to avoid the 1.5 percent penalty for 2013.
Practitioners who e-prescribed at least 25 times during 2011 or who e-prescribe at least 10 times between Jan. 1 and June 30, 2012 can avoid the 2013 penalty . These e-prescriptions must be signified with the G code G8553 on claims submitted indicating that the e-prescription was written in conjunction with a Medicare Part B service. In addition, hardship exemptions are also available to practitioners who meet the elgibility requirements and who submit an exemption application to the Centers for Medicare and Medicaid Services (CMS) by June 30.
Hardships exemptions are available to providers who are unable to electronically prescribe due to local, state, or federal law, or regulation; have or will prescribe fewer than 100 prescriptions during a six-month reporting period (Jan. 1 – June 30); practice in a rural area without sufficient high-speed Internet access (G8642); or practice in an area without sufficient available pharmacies for e-prescribing (G8643). Hardship exemptions must be submitted through the Quality Reporting Communication Support Page no later than June 30. These requests are granted on a case-by-case basis and all decisions are final. Given the issues experienced last year by providers trying to request exemptions via the website, CMS has developed two documents outlining how to navigate the support page (Quality Reporting Communication Support Page User Guide and Tips for Using the Quality Reporting Communication Support Page).
It’s important to note that physicians participating in the Electronic Health Record (EHR) Incentive Program must also participate in the E-Prescribing Incentive Program in order to avoid the 2013 penalty (see related story).
Getting Your E-Prescribing Incentive Payment
In addition to avoiding the penalty, January 2012 also marked the beginning of a new year for the E-Prescribing Incentive Program. Those who meet all of Medicare’s requirements can earn an additional one percent on top of their Medicare Part B earnings. In order to qualify for the incentive payment, practitioners must meet the following requirements:
- E-prescribe at least 25 times between Jan. 1 and Dec. 31, 2012
- Perform the e-prescribing at the time a service included in the denominator is provided
- Signify the e-prescription by reporting G-8553 on claims submitted to Medicare or through a registry
- Not be participating in the Electronic Health Record (EHR) Incentive Program.
The denominator codes are:
90801 90862 99201 99214 99310 99334 99345
90802 92002 99202 99215 99315 99335 99347
90804 92004 99203 99304 99316 99336 99348
90805 92012 99204 99305 99324 99337 99349
90806 92014 99205 99306 99325 99341 99350
90807 96150 99211 99307 99326 99342 G0101
90808 96151 99212 99308 99327 99343 G0108
90809 96152 99213 99309 99328 99344 G0109
For more information on the E-Prescribing Incentive Program, click here.