Recently, the Centers for Medicare & Medicaid Services (CMS) promulgated a final rule relating to the CMS Electronic Prescribing (e-Prescribing) Incentive Program created by the Medicare Improvements for Patients and Providers Act of 2008. In 2012, CMS will apply a penalty to those eligible professionals who do not either (1) meet the 2011 e-Prescribing Incentive Program reporting requirements during the 6-month reporting period of January 1-June 30, 2011, or (2) qualify for a significant hardship exemption. The 2012 penalty will equal 1 percent of the eligible professional’s Part B covered professional allowed charges under the Medicare Physician Fee Schedule (PFS) for claims submitted with a January 1-December 31, 2012 date of service. Payment penalties increase to 1.5 percent in 2013 and 2 percent in 2014. While the American Society of Anesthesiologists supports the concept of the E-Prescribing Incentive Program, we have expressed our concerns to CMS that the program will quickly eliminate any incentives to encourage adoption of this technology before it has even grown beyond its infancy. ASA advocated for and was pleased to see CMS adopt additional flexibility for eligible professionals to qualify for exemptions and avoid the payment penalties.
The 10 Percent Threshold
If Part B allowable charges are less than 10 percent of the eligible professional’s entire Medicare Part B business, that eligible professional is exempt from the 1 percent penalty in 2012. CMS will use data from the January 1-June 30, 2011 reporting period and CMS will make that determination. However, eligible professionals should make this determination based on submitted charges to determine if no hardship application is necessary. If an eligible professional has 10 percent or more Part B allowable charges they may be subject to the penalty; however, if that eligible professional has limited prescribing activity, those that prescribed fewer than 10 prescriptions between January 1, 2011 and June 30, 2011 they may still apply for a hardship exemption under the limited prescribing activity criteria, which CMS will review on a case-by-case basis. More information on the ten percent threshold can be viewed here.
If an eligible professional has fewer than 100 encounters defined by the eRx denominator codes with Medicare Part B patients, they are also exempt from the 1 percent penalty in 2012. CMS will use data from the January 1-June 30, 2011 reporting period and CMS will make that determination. Again, in this instance, no hardship application is needed, but eligible professionals should make their own determination if they had fewer than 100 encounters.
If an eligible professional has 10 percent or more Part B allowable charges or more than 100 eligible encounters they may apply for a hardship exemption to avoid the penalty, if appropriate.
Eligible professionals that meet certain criteria and do not fall within the scenarios outlined above can apply for a hardship exemption and avoid the payment penalty; however, eligible professionals are required to request the exemption from CMS by November 8, 2011, using the Web-based tool . Those who wish to seek a group practice exemption must request through the mail. Such mail requests must be postmarked by November 1. Practices applying for a hardship exemption must meet one of the following criteria to be considered.
(A)The practice is located in a rural area without high speed internet access.
(B) The practice is located in an area without sufficient available pharmacies for electronic prescribing.
(C) Registration to participate in the Medicare or Medicaid EHR Incentive Program and adoption of Certified EHR Technology by October 1.
(D) Inability to electronically prescribe due to local, State or Federal law or regulation. (CMS confirmed that physicians who mainly prescribe narcotics but cannot submit these prescriptions electronically because of certain limitations can apply for this exemption category.)
(E) Limited prescribing activity.
(F) Insufficient opportunities to report the eRx measure due to limitations of the measure's denominator.
The exemption request must include identifying information, which includes the TIN, NPI, name, mailing address, and email address of all affected eligible professionals. Providers must state at least one reason they are requesting an exemption from the list above. They must justify why they qualify for that exemption; for example, if a provider is requesting on the basis of limitations due to a local, state or federal law, they must reference the specific law or regulation. CMS determines if the practice qualifies for a hardship exemption.
View the manual that further explains how individual practices can apply for a hardship exemption.
After reading the manual, individual practices can use the web-tool and apply.
View the CMS 2012 e-Prescribing Adjustment Feedback Report User Guide.