CMS Modifies E-Prescribing Payment Adjustment Rule

June 1, 2011 – With the deadline right around the corner for the submission of 10 electronic prescriptions to avoid the 2012 payment adjustment penalty, CMS issued a proposed rule last Thursday to increase the number of hardship exemptions from this eRx measure. 
 
To avoid the 2012 payment adjustment penalty, the rule originally required participation of eligible professionals (EPs) who performed the required number of eligible E & M codes during the time period of January 1 through June 30, 2011, even if they were unable to prescribe the 10 electronic prescriptions due to the nature of their medical specialty/practice or because of the limitations of the eRx measure itself.

Since this rule was published as part of the 2011 Physician Fee Schedule final rule with comment, CMS has received many complaints that CMS is unfairly penalizing these EPs by making them comply with a rule that they can not fulfill.  Along with the complaints came numerous suggestions to expand the categories under the significant hardship exemption for the 2012 eRx payment adjustment.  
 
CMS agreed with four of the circumstances raised by stakeholders’ comments that unfairly penalized certain EPs.  In an effort to correct this, CMS is proposing the following exemption categories for those 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. Limited Prescribing Activity – An EP who has prescribing privileges but does not prescribe or very infrequently prescribes in his or her own practice;
2. 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);
3. 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;
4. EPs who Register to Participate in the Medicare or Medicaid EHR Incentive Programs and Adopt Certified Technology– EPs who intended to participate in the EHR Incentive Program may have delayed adopting eRx technology for the purposes of the eRx Incentive Program until the list of certified EHR technology became available so that the same technology could be used to satisfy both programs’ requirements. EPs under the Medicare EHR Incentive Program have until October 1, 2011to begin a 90-day EHR reporting period for the 2011 payment year; thereby missing the June 30, 2011 deadline.

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

1. Identifying information such as theTIN, NPI, name mailing address, and email address of all affected professionals
2. The significant hardship exemption category(ies) that apply
3. 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.
4. An attestation of the accuracy of the information provided

The EP or Group Practice must submit the hardship request by no later than October 1, 2011.  CMS is proposing the set up of a web-based tool or interface to use for this request.  However, they can not state that this tool will be completed by the October deadline.  If the tool is not completed, mailed requests must be postmarked no later than October 1, 2011. 

If the rule is not finalized by October 1, 2011, CMS proposes that requests be received within 5 days of the date the rule is finalized.  Requests may not be faxed or emailed to CMS.
 
At the same time, CMS is proposing to extend the deadline for the two (2) current hardship exemptions.  Those exemptions are:

• 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)

Although the time to request the exemption has been extended from June 30, 2011 to October 1, 2011, EPs or group practices must still submit, via claims-based submission, the appropriate G-code before the June 30, 2011 deadline.
 
If you fall into any of these four new categories, you may want to begin gathering the information necessary to submit a request for exemption to the eRx measure.  We will be publishing a more detailed information sheet on this proposed rule.  Please contact your client manager for a copy or you may click below for more information on this proposed rule.

Tags: eRx Incentive Program