Extra month to seek hardship exemption to eRx penalty

If you failed to meet the June 30 electronic prescribing (eRx) deadline, you’ve got an extra month to avoid a cut in next year’s Medicare payment. Final changes to the 2011 Electronic Prescribing Incentive program granted a reprieve to providers, allowing them until November 1 to submit a request for a hardship exemption instead of the October 1 deadline proposed earlier this year.

To qualify for the incentive payment-and avoid the penalty-most physicians needed to report at least 10 electronic prescriptions to the Centers for Medicare and Medicaid Services (CMS) between January 1 and June 30 of this year. In the proposed rule released in June 2010, physicians who did not meet the deadline and did not qualify for one of the two initial exemptions would see their 2012 payments under the Medicare Physician Fee Schedule reduced by 1%. Those who did not use electronic prescribing in following years would be docked 1.5% in 2013 and 2% in 2014.

The final rule allows eligible professionals to request exemption from the payment adjustment if they:

• practice in rural areas with limited access to high-speed Internet;
• practice in areas where few pharmacies accept eprescribing;
• register to participate in an electronic health record (EHR) incentive program and adopt, implement or upgrade certified EHR technology by October 1, 2011;
• are prohibited by law or regulation from electronically prescribing;
• write few prescriptions; or
• have insufficient opportunities to report the eRx measure.

In addition, providers who had fewer than 100 claims for patient services from January 1 to June 30 are not subject to the payment adjustment and do not need to file for an exemption.

Many physicians who were not able to e-prescribe during the first 6 months of the year may qualify for one of the exemptions based on CMS’ responses to comments contained in the rule. For instance, physicians affected by the floods in the Midwest this spring might qualify because, during the time period, few pharmacies in their area were able to accept e-prescriptions or because the disruption created a situation where they wrote few prescriptions. Physicians whose Drug Enforcement Agency registrations lapsed during the reporting period or nurse practitioners who cannot prescribe under their own identifiers could also qualify for the “few prescriptions” exemption.

Similarly, physicians who primarily provide Medicare services not included in the eRx measure’s denominator, such as postoperative visits (CPT99024) or Medicare wellness visits (G0438), may qualify for exemption “due to insufficient opportunities to report the eRx measure due to limitations of the measure’s denominator.”

The exemption for physicians who use EHR technology certified under the Medicare and Medicaid EHR incentive program eliminates the need for practices to acquire and use two separate programs-one to qualify for the EHR incentives and another to avoid the eRx penalty.

Physicians or practices may continue to use eRx technology that meets the requirements in the original rule, which are somewhat different than those specified for eRx modules in certified EHRs. Eligible providers cannot receive incentive payments under both the EHR and the eRx programs in the same year, but they must qualify for the eRx incentive to avoid the payment penalty.

Individual eligible providers must apply for an exemption by November 1 using a Web-based tool that will be available on the eRx incentive program Web site. Physicians are encouraged to apply for exemptions as soon as possible to avoid the need for reprocessing of claims paid in early 2012, which CMS anticipates “may take several months.” Group practices must submit joint exemption requests.

Go back to the current issue of eConsult.