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Dec 03

2011 Medicare electronic prescribing incentive program update

 

In November CMS announced that beginning in 2012, Eligible Professionals (EPs) who are not successful electronic prescribers may be subject to a payment adjustment or penalty. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the EP is planning to participate in the Electronic Prescribing (eRx) Incentive Program. 
 
The payment adjustment in 2012, with regard to all of the EPs’ Part B-covered professional services, will result in the EP or group practice receiving 99 percent of the Physician Fee Schedule (PFS) amount that would otherwise apply to the services. In 2013, EPs will receive 98.5 percent of their covered Part B-eligible charges if they are not a successful electronic prescriber. In 2014, the penalty for not being a successful electronic prescriber is 2 percent, resulting in EPs receiving 98 percent of their covered Part B charges.

For purposes of determining which EPs or group practices are subject to the payment adjustment in 2012, CMS will analyze claims data from January 1 – June 30, 2011, to determine if the EP has submitted at least 10 electronic prescriptions during the first six months of Calendar Year (CY) 2011. Group practices reporting as Group Practice Reporting Option (GPRO) I or GPRO II in 2011 must report all of their required electronic prescribing events in the first six months of 2011 to avoid the payment adjustment in 2012.

 
Please see the How to Get Started Web page External Link Icon for more information or download Medicare’s Practical Guide to the Electronic Prescribing (eRx) Incentive Program under Educational Resources.
 
If an EP or selected group practice wishes to request an exemption to the eRx Incentive Program and the payment adjustment, there are two “hardship codes” that can be reported via claims should one of the following situations apply:
  • G8642 – The EP practices in a rural area without sufficient high-speed Internet access and requests a hardship exemption from the application of the payment adjustment under Section 1848(a)(5)(A) of the Social Security Act (SSA).
  • G8643 – The EP practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the application of the payment adjustment under Section 1848(a)(5)(A) of the SSA.  
Additionally, there will be a “G” code that can be used by EPs to indicate they do not have prescribing privileges. Reporting this “G” code will prevent the EP from being subjected to a payment adjustment in 2012.
 
(CMS Learn Resource 201011-46)
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