e-Rx

Changes to CMS 2011 E-Prescribing Program

The following information was prepared by the American College of Physicians’ (ACP) Regulatory & Insurer Affairs Department for informational purposes only. It is also posted on the ACP site.

The Centers for Medicare and Medicaid Services (CMS) recently released a final rule that updates the Electronic Prescribing (eRx) Incentive Program for 2011. The rule expanded the definition of the type of eRx systems that would qualify for the 2011 incentive and the 2013 payment adjustment reporting requirements and expanded the number of hardship exemptions in the program, which would provide Eligible Professionals (EP) or Group Practices (GP) an opportunity to avoid a penalty (payment adjustment) scheduled to take place in 2012. More specifically, under current regulations, EP will be penalized 1% of total allowed Medicare charges submitted throughout 2012 if they did not report a minimum of 10 eRx reporting events during the six-month period of January 1, 2011 to June 30, 2011. Under current law, EP will be penalized 1.5% if they do not report a minimum of 25 eRx events during the 12-month period of January 1, 2011 to December 31, 2011. GP have similar, but expanded, requirements.

A full summary of the 2011 eRx Incentive Program and the 2012 and 2013 Payment Adjustment regulations prior to this update is available on the ACP site here. It is recommended that you review this summary prior to reviewing the modifications implemented by this final rule.

The following is a list of the approved changes to the 2011 CMS eRx program.

  • Expanded the definition of the type of eRx systems eligible to meet the eRx incentive and eRx payment adjustment reporting requirements. More specifically, it expanded the definition of a qualified system to include eRx capabilities within “Certified EHR Technology” systems that qualify under the Medicare and Medicaid EHR “Meaning Use” Incentive Program.
  • The new proposed hardship exemptions:
    • EP or GP who register to participate in the Medicare or Medicaid EHR Incentive Programs and adopt certified EHR technology. The EP must report the “CMS EHR Certification ID” of their Certified EHR system when applying for this exemption.
    • EP or GP who are unable to electronically prescribe due to local, state, or federal law or regulation (e.g. prescriptions for controlled substances).
    • EP or GP who engage in limited prescribing activity, while still having prescribing privileges (e.g. an EP that prescribed fewer than 10 prescriptions between January 1, 2011 and June 30, 2011).
    • EP or GP who have insufficient opportunities to report the electronic prescribing measure due to limitations of the measure’s denominator (e.g. physicians, such as many surgeons, who do not normally write prescriptions associated with the type of visits included in the eRx measure).

CMS will allow EP and GP to submit hardship requests by no later than November 1, 2011. In addition, CMS has extended the deadline date to November 1, 2011 for the following two hardship exemptions that were already a part of the 2011CMs eRx program:

  • The EP or GP is in a rural area with limited high speed Internet access.
  • The EP or GP is in an area with limited available pharmacies for electronic prescribing.

All hardship exemption submissions will be reviewed on a case by case basis. EP and GP can apply for more than one exemption category. Hardship exemption submissions by EP must be made through the CMS Quality Reporting portal. Any questions related to using this portal should be directed to the Quality Net Help Desk at 1-866-288-8912 or via email at Qnetsupport@sdps.org.

GP must submit hardship exemptions by mail at Significant Hardship Exemptions, Office of Clinical Standards and Quality, Quality Measurement and Health Assessment Group, 7500 Security Boulevard, Mail Stop S3-02-01 Baltimore, Maryland 21244-1850.

Hardship exemption submissions will be required to include the following:

  • Relevant identify information, i.e. TIN, NPI, name, mailing address, and email address of all affected EP.
  • The significant hardship exemption category that is applicable.
  • A justification statement for the exemption.
  • An attestation of the accuracy of the information being provided.

A CMS quick reference summary of the changes to the 2011 eRx program can be downloaded here.

The full CMS eRx 2011 Update final rule is available here.

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