Last chance for e-prescribing penalty exemption

posted 10.18.11

Physicians who did not submit 10 e-prescribing claims by June 30, 2011, will receive a 1-percent penalty applied to the Physician Fee Schedule starting Jan. 1, 2012. You have until Nov. 1, 2011, to apply for an exemption. If you are unsure if you are subject to the penalty or unsure if you successfully sent 10 e-prescriptions by the June deadline, the Texas Medical Association recommends you review the exemptions and apply as soon as possible if one pertains to your hardship and if you want to be considered for an exemption to the penalty.

You are automatically exempt from the 2012 e-prescribing penalty if:

• You submitted fewer than 100 denominator eligible claims to Medicare. (See TMA's 2011 E-Prescribing White Paper to view eligible denominator codes.)
• Less than 10 percent of your allowed charges from Jan. 1, 2011, through June 30, 2011, comprise denominator eligible codes.

When you submit your exemption request, include the following information:

• Identifying information (Tax Identification Number, individual National Provider Identifier, name, mailing address, and e-mail address);
• The applicable hardship exemption category; and
• A statement of justification that outlines how compliance with the e-prescribing program resulted in a significant hardship to you.

Physicians have the opportunity to attest to one or more of the following exemptions. Physicians with more than one exemption should include this in the text of the request:

• Physician is registered to participate in the Medicare or Medicaid Electronic Health Record (EHR) Incentive Program, has adopted certified EHR technology, and intends to qualify for an incentive for payment year 2011.
• Physician is unable to electronically prescribe due to local, state, or federal law or regulation (e.g., he or she prescribes controlled substances).
• Physician infrequently prescribes (e.g., he or she wrote fewer than 10 prescriptions between Jan. 1, 2011, and June 30, 2011).
• There are insufficient opportunities to report the e-prescribing measure due to program limitations.
• Physician's practice is in a rural area without high-speed Internet access.
• Physician's practice is in an area without sufficient available pharmacies for electronic prescribing.

For more information about reporting an exemption, CMS has posted an e-prescribing exemption instruction guide.

These changes are largely a result of the concerns expressed by physicians across the country. TMA urged the Centers for Medicare & Medicaid Services to revise the current e-prescribing penalties.

Receive a 1 percent Medicare Incentive for 2011

There is still time to receive a 1 percent Medicare bonus by successfully e-prescribing 25 prescriptions (and report it on a claim form with G-code G8553) by Dec. 31. Writing 25 e-prescriptions by Dec. 31 also prevents a 2013 e-prescribing penalty. Details on the e-prescribing program are available in TMA's 2011 E-Prescribing informational paper. E-mail or call the TMA HIT helpline at (800) 880-5720 for more information.

If you need help with e-prescribing, turn to the Texas regional extension centers (RECs). RECs provide support to primary care physicians to help with e-prescribing, EHR selection, workflow analysis, staff training, EHR incentives, and more. At a cost of $300 per eligible physician, you can get a consultant on site at any location in Texas. Visit TMA's Texas REC Resource Center for more information.