ePrescribing-Penalty

Overview — Medicare 2012 E-Prescribing Incentive (eRx) & 2013 Penalty Program

Many providers were caught off guard by the e-prescribing penalty that started earlier this year. Unfortunately, there is nothing you can do at this point to stop the penalty on 2012 claims but it is not to late to avoid next year’s penalty. For those who are unfamiliar with the program and what you need to do to avoid penalties, the following is a brief overview, along with exemptions and instructions on how to submit the right information to CMS for both 2013 and 2014.

Basic Information

  • Eligible professionals (EP) who did not become successful e-prescribers by the end of 2011 or are unable to successfully submit at least 10 eRx claims by June 30, 2012, will face a 1.5% penalty for charges submitted in 2013. (eRxs submitted during the six-month period to avoid the penalty do not need to be linked to the incentive defined service codes.)
    • Exclusions and hardship exemptions do apply. Hardship requests to avoid the 2013 penalty must be submitted between March 1, 2012 and June 30, 2012.
  • Eligible professionals who do not become successful e-prescribers by the end of 2012 or successfully submit at least 10 eRx claims by June 30, 2013, will face a 2% penalty for charges submitted in 2014. (eRxs submitted during the six-month period to avoid the penalty do not need to be linked to the incentive defined service codes.)
    • Exclusions and hardship exemptions do apply.

Hardship Exemptions and Codes

  • Inability to electronically prescribe due to state or federal law, or local law or regulation.
  • The eligible professional prescribes fewer than 100 prescriptions during a 6-month payment adjustment reporting period.
  • The eligible professional practices in a rural area without sufficient high-speed Internet access (G8642).
  • The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing (G8643).

How to Submit a Hardship Request

  • CMS established the Quality Reporting Communication Support Page at http://www.qualitynet.org/pqrs for eligible professionals to submit hardship requests, including those associated with a G-code. For more information detailing how to navigate the Quality Reporting Communication Support Page, please reference the following documents:
    • “Quality Reporting Communication Support Page User Guide” click here to download (.pdf).
    • “Tips for Using the Quality Reporting Communication Support Page” at http://www.cms.gov/ERxIncentive/20_Payment_Adjustment_Information.asp on the CMS website.
    • A hardship G-code may also be submitted at least once on a claim during the six-month 2013 eRx payment adjustment reporting period, if applicable.
    • The hardship G-code must be submitted on a claim with a billable Medicare Part B service.  The hardship G-code does not need to be submitted on a claim that contains eRx measure denominator code

Claims-Based Reporting Principles for 2012 Electronic Prescribing (eRx) Incentive Program

For successful reporting under the 2012 eRx Incentive Program, a single quality-data code (eRx G-code) should be reported, according to the following coding and reporting principles:

  • Report the following eRx numerator G-code, when applicable: o G8553 — At least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system (faxes do not count).
  • The eRx G-code, which supplies the numerator, must be reported: o on the claim(s) with the denominator billing code(s) that represent the eligible encounter for the 2012 eRx incentive payment; OR on the claim(s) with any billing code(s) that represent the encounter to avoid the 2013 eRx payment adjustment
    • for the same beneficiary
    • for the same date of service (DOS)
    • by the same eligible professional (individual NPI) who performed the covered service as the payment codes, usually CPT Category I or HCPCS codes, which supply the denominator

For further Information:

CMS: www.cms.gov/erxincentive

CMS offers a QualityNet Help Desk from 7:00 AM – 7:00 PM CST that will answer questions regarding the Medicare eRx program.

Email     Qnetsupport@sdps.org

Phone    1-866-288-8912

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