Medical Societies Seek Medicare e-Prescribing Changes

In its proposed rule making changes to the Medicare electronic prescribing incentive program, the Centers for Medicare and Medicaid Services is not giving physicians enough time to understand and comply with "last minute modifications" before a 1 percent reimbursement penalty for non-compliance begins in 2012, according to the American Medical Association and 91 other medical societies.

Consequently, the organizations in a comment letter to CMS advocate delaying imposition of penalties until 2013 for physicians facing a 2012 penalty. Further, "We strongly urge CMS to establish an additional reporting period in 2012 (e.g., January 1, 2012-June 30, 2012), so that physicians have an additional opportunity to successfully e-prescribe to avoid the 2012 eRx penalty."

CMS in 2010 ruled that physicians could not participate in both the Medicare eRx incentive program and the Medicare EHR meaningful use program, but has since partly reversed course, saying it can only get incentives from one of them. But another reporting period is necessary because Medicare's educational campaign for eRx in 2010 "was extremely misleading" because many physicians still believe they can't participate in both programs, according to the medical societies. "Despite our efforts to reach and educate every physician who may be adversely affected by the Medicare eRx penalty program, more needs to be done to educate physicians, especially now on the proposed modifications to the eRx penalty program."

Applying a 1 percent Medicare payment cut to physicians who do not successfully report in the eRx program would be unworkable in its current form because CMS has said it will not publish separate payment schedules and limiting charges reflecting application of the penalty, the societies contend. "The only way physicians would know what their reduced allowed charges and their patients' co-payments would be is by waiting for the remittance advice from Medicare. This would seriously complicate what is already likely to be a logistical nightmare, leading thousands of physicians to think that Medicare is paying them incorrectly and thousands of patients being charged incorrectly. As you know, many physicians collect co-payments at the time of service and it would add greatly to their costs if they had to change to billing for them weeks later after the remittance advice is received. At a time when everyone is looking for more transparency in patient cost-sharing, this is a major step backwards."

As a solution, the societies note that CMS presently pays eRx incentives following the conclusion of the reporting period. "We urge CMS to apply this same protocol for the eRx penalty program by only requiring physicians who are subject to 2012 penalties to replay the amount owed after the calendar year 2012 reporting period has concluded."

The medical societies also ask for inclusion of four additional eRx exemption categories:

* The physician is registered to participate in the Medicare or Medicaid EHR incentive programs and has adopted certified EHR technology;

* The physician is unable to e-prescribe because of local, state or federal regulation;

* The physician prescribes less than 10 prescriptions between Jan. 1, 2011, and June 30, 2011; and

* There are insufficient opportunities to report the eRx measure because of program limitations, such as a surgeon who does not frequently use permissible service codes under the program.