CMS: Deadline Nears to Avoid Medicare eRx Payment Penalty

The Centers for Medicare and Medicaid Services has published guidance on avoiding a 2 percent reduction in Medicare payments for physicians who are not participating in the Electronic Prescribing Incentive Program by June 30, 2013:

“A major Electronic Prescribing (eRx) Incentive Program deadline is approaching for both individual eligible professionals (EPs) and group practices participating in the Group Practice Reporting Option (GPRO).  If you are an EP or an eRx GPRO participant, you must successfully report as an electronic prescriber before June 30, 2013 or you will experience a payment adjustment in 2014 for professional services covered under Medicare Part B's Physician Fee Schedule (PFS.)

“The 2013 eRx Incentive Program 6-month reporting period (January 1, 2013 to June 30, 2013) is the final reporting period available to you if you wish to avoid the 2014 eRx payment adjustment.

If you do not successfully report, a payment adjustment of 2.0% will be applied, and you will receive only 98.0% of your Medicare Part B PFS amount for covered professional services in 2014.

Avoiding the 2014 eRx Payment Adjustment

“Individual EPs and eRx GPRO participants who were not successful electronic prescribers in 2012 can avoid 2014 eRx payment adjustment by meeting specified reporting requirements between January 1, 2013 and June 30, 2013. Below are the 6-month reporting requirements:

* Individual EPs – 10 eRx events via claims

* eRx GPRO of 2-24 EPs – 75 eRx events via claims

* eRx GPRO of 25-99 EPs – 625 eRx events via claims

* eRx GPRO of 100+ EPs – 2,500 eRx events via claims

Exclusions and Hardships Exemptions

“Exclusions from the 2014 eRx payment adjustment only apply to certain individual EPs and group practices, and CMS will automatically exclude those individual EPs and group practices who meet the criteria. More information on exclusion criteria and hardship exception categories can be found on the Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment Fact Sheet.

Resources from CMS

“Additional resources on the 2014 payment adjustment are available on the eRx Incentive Program Payment Adjustment Information webpage, including the resource Electronic Prescribing (eRx) Incentive Program: Updates for 2013.

Questions about eRx?

“If you have questions regarding the eRx Incentive Program, eRx payment adjustments, or need assistance submitting a hardship exemption request, please contact the QualityNet Help Desk at 866-288-8912 (TTY 1-877-715-6222) or via qnetsupport@sdps.org. The Help Desk is available Monday through Friday from 7am-7pm CT.

“To learn more about the eRx Incentive Program and program alignment under the CMS eHealth initiative, please visit www.CMS.gov/eHealth.”