E-Prescribing Penalties Kicked In Jan. 1, 2012

If you were not a “successful electronic prescriber” in 2011 under Medicare’s e-prescribing incentive program (and you were not exempt), you will be penalized 1 percent on all your Medicare Part B payments in 2012.  

Medicare will automatically adjust your 2012 Part B payments; you will see the term “LE” on your remittance advice. The remittance advice also will contain the following codes:

  • Claim Adjustment Reason Code (CARC) 237 — Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).
  • Remittance Advice Remark Code (RARC) N545 —Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing (e-prescribing) Incentive Program. 

Note that Medicare will apply the 2012 e-prescribing penalties separately from the 2011 e-prescribing incentive program or any other Centers for Medicare & Medicaid Services (CMS) incentive program payments. 

Note also that the e-prescribing penalties will go into effect regardless of whether the 2012 Medicare physician fee schedule for 2012 goes up or down. Physicians who become successful prescribers in 2012 can be made whole in 2013 and will not be subject to the penalty continuously, as follows:

2011

2012

2013

Not Successful

1 percent penalty

Successful  — .5 percent bonus

No penalty

For more information about the 2012 Medicare e-prescribing incentive program, visit TMA’s e-prescribing webpage and CMS’ program Spotlight page. For details about the 2012 penalty, see CMS’ Quick-Reference Guide for Understanding the 2012 Electronic Prescribing (eRx) Payment Adjustment (PDF).

Published Jan 17, 2012


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