CMS Announces Changes to the Medicare eRx Incentive Program for Calendar Year 2011

September 7, 2011 – Since publication of the 2011 MPFS (Medicare Physician Fee Schedule) Final Rule, CMS received many public comments concerning the eRx Incentive Program which resulted in CMS revising some of the provisions of the eRx program.
 
On August 31, 2011, CMS announced the following changes to the Medicare Electronic Prescribing (eRx) Incentive Program for Calendar Year 2011 for those eligible professionals (EPs) or group practices who electronically prescribe, meet the 10-percent threshold and have at least 100 CPT eligible visits between January 1 and June 30, 2011.
 
1.  CMS has approved the following additional hardship exemption categories for purposes of the 2012 payment adjustment.  The deadline to report one or any of these hardship exemption categories is November 1, 2011.

• Limited Prescribing Activity – An EP who has prescribing privileges but does not prescribe or very infrequently prescribes in his or her own practice;
• Insufficient Opportunities to Report the eRx measure due to limitations of the Measure’s Denominator(CPTcode(s)) – An EP who does not normally write prescriptions associated with any types of visits included in the eRx’s denominator code because the bulk of their prescribing activity occurs in other circumstances that are not accounted for by the measure’s denominator (CPTcode);
• Inability to Electronically Prescribe Due to Local, State or Federal Law or Regulation – EPs who prescribe large volumes of narcotics, which may not be electronically prescribed in some states, or EPs who practice in a State that prohibits or limits the transmission of electronic prescriptions via a third party network;

2. CMS has extended the deadline to report the two significant hardship exemptions established in the CY 2011 MPFS Final Rule to November 1, 2011.

• EPs or group practices that practice in rural areas with limited high speed internet access (G8642) and
• EPs or group practices that practice in an area with limited available pharmacies for eRx (G8643)

3.  CMS will require submission of significant hardship exemption requests for the 2012 eRx payment adjustment via:

• a web-based tool for individual eligible professionals and
• a mailed letter for group practices that are participating in the 2011 eRx group practice reporting option.  Although in June,CMSproposed to allow group practices to submit their exemption requests via a web-based tool; for technical reasons,CMSwill now not allow them to do so.  Group practices  participating in the eRx group practice reporting option must submit a mailed letter containing all the information specified in the requirements below.

In order to request a hardship exemption for any of the hardship categories, an EP or group practice must submit the following information toCMS:

• Identifying information such as theTIN, NPI, name mailing address, and email address of all affected professionals
• The significant hardship exemption category(ies) that apply
• A justification statement describing how compliance with the requirement for being a successful e-prescriber for the 2012 eRx payment adjustment during the reporting period would result in a significant hardship to the EP or group practice.
• An attestation of the accuracy of the information provided

Information on how to access the Web-based tool as well as detailed instructions for applying for a significant hardship exemption should be available in the near future on the eRx Incentive Program website at:  http://cms.gov/erxincentive

4. CMS has included EHR Certified Technology as a Qualified eRx System
 
CMS modified the existing 2011 electronic prescribing measure to address uncertainties related to the technological requirements of the Medicare eRx Incentive Program.  The existing 2011 electronic prescribing measure is revised to indicate that a qualified electronic prescribing system includes certified EHR technology as defined at 42 CFR 495.4 and 45 CFR 170.102, regardless of whether the Certified EHR Technology has all four of the required functionalities of the original eRx incentive program.
 
However, this change will not take place until the effective date of this final rule, which is October 6, 2011, and will only be effective for the remainder of the reporting period in CY 2011 for the 2011 eRx incentive and the 2013 eRx payment adjustment.
 
If an EP did not submit the required ten (10) e-prescribe measures via claims-submission before June 30, 2011, because the EP intended to apply the use of EHR Certified Technology for prescriptions, the EP will still receive payment adjustment penalties for 2012. 
 
A copy of this final rule can be found at:

CMS Changes to eRx Program

Tags: eRx Incentive Program