MLR

Deadline nears to avoid eRx penalties in 2014

Categories:

June 30 is fast approaching, leaving physicians with only a short time to act to avoid Medicare’s 2 percent penalty under the Electronic Prescribing (eRx) Incentive Program.

pills on hundred dollar bill

Eligible professionals and groups that report through the group practice reporting option (eRx GPRO) and failed to meet e-prescribing reporting requirements for the 12 months ended Dec. 31, 2012, must meet the requirement between Jan. 1 and June 30, 2013. Those who do not will receive only 98 percent of their Medicare Part B fee-for-service payment for covered professional services next year.

New hardship exemptions

Hardship exemptions are available under certain circumstances. The Centers for Medicare & Medicaid Services (CMS) added two new exemption categories:

  • Meaningful use achievers under the Medicare or Medicaid Electronic Health Record Incentive Program – Physicians must have achieved meaningful use during the 12-month eRx reporting period (Jan. 1, 2012 – Dec. 31, 2012) or the current six-month eRx reporting period (Jan. 1, 2013 – June 30, 2013).
  • Those who have demonstrated the intent to participate in those programs – Physicians must have registered for the program, providing Electronic Health Record (EHR) certification identification, and must have adopted certified EHR technology by Jan. 31, 2013.

Physicians do not need to apply for these two exemptions. CMS will review the EHR Incentive Program Attestation and Registration system and will automatically process those eligible for the exemptions.

Application for other exemptions

Eligible physicians must apply by June 30, 2013, for other exemption categories identified by CMS, even if a hardship exception was granted for the 2013 payment adjustment. Hardship exceptions are subject to annual renewal.

Eligibility for a hardship exception is made on a case-by-case basis and is limited to those that fit one of the following descriptions:

  • Are located in a rural area with limited high-speed Internet access (G8642);
  • Are in an area with limited available pharmacies for electronic prescribing (G8643);
  • Are unable to electronically prescribe due to local, state or federal law or regulation (e.g., prescribing controlled substances); or
  • Generate fewer than 100 prescriptions during a six-month reporting period.

Eligible professionals who do not have prescribing privileges between Jan. 1, 2013, and June 30, 2013, can report G8644 on a payable Medicare Part B service at least once on a claim during that six-month period to avoid the 2014 eRx payment adjustment.

Hardship exemption requests should be submitted through CMS’s Quality Reporting Communication Support Page. Go to the website www.qualitynet.org/portal/server.pt/community/communications_ support_system/234.

Hardships with G codes may also be submitted by individual eligible professionals at least once between Jan. 1 and June 30, 2013, on a claim with a payable Medicare Part B service that contains eRx measure denominator codes.

Minimum report requirements

If not eligible for a hardship exemption, physicians can avoid the penalty by reporting at least 10 electronic prescribing events (G8553) on any billable Medicare Part B fee-for-service claim with a date of service during the six months ending June 30, 2013.

Unlike the requirement to receive a bonus, the eligible claim does not have to contain coding in the eRx measure’s denominator.

Individual eligible professionals who worked under more than one tax identification number (TIN) during 2012 and/or 2013 must meet the reporting criteria for each TIN to avoid the 2014 penalty. Electronically generated refills do not count, and faxes do not qualify as electronic prescriptions. Data must be processed into the National Claims History no later than July 26, 2013.

Last chance for eRx incentive

This year is the last reporting period to earn an eRx incentive payment, which will be 0.5 percent of 2013 allowed charges for covered professional services. To be eligible for a payment, a physician must report at least 25 unique denominator-eligible eRx events for services provided Jan. 1 through Dec. 31, 2013.

All claims must be reported by Feb. 24, 2014. Only denominator-eligible events count toward a physician’s eligibility to receive an eRx bonus payment.

The 2013 eRx Incentive Program denominator has changed. For the new encounter codes, visit the www.cms.gov website, click on Medicare and scroll down to Quality Initiatives. Then click on Electronic Prescribing Incentive Program and Electronic Prescribing Measures to access the 2013 eRx Measure Specifications file under Related Links.