Watch for E-Prescribing Overpayments

Texas Medicare contractor Novitas Solutions has identified a problem with files the Centers for Medicare & Medicaid Services (CMS) provides that are supposed to show physicians who did not meet CMS requirements for e-prescribing. The files are not showing this information, and physicians are not being penalized 1 percent as required by the e-prescribing rules. Thus, they are being overpaid, and CMS will want the money back.

Novitas is working with CMS to resolve this problem. Watch the Novitas System Alerts for an update.

Who is subject to 1-percent penalty? If you did not e-prescribe and report the G-code G8553 at least 10 times by June 30, 2011, or claim a valid exemption by Nov. 7, 2011, you were penalized 1 percent of your 2012 Medicare Part B claims. Some of your claims for 2012 will include the overpayment.

2013 e-prescribing reminder: You have until June 30 to avoid a 2-percent penalty on all 2014 Medicare Part B claims. If you do not already e-prescribe in your office, now is the time to begin. If you do not already use an electronic health record (EHR) system with e-prescribing capabilities, you can install a stand-alone e-prescribing system and still meet the approaching deadline. You must report e-prescribing via claims using G-code G8553 on at least 10 unique Medicare encounters by June 30 to prevent the penalty. Three prescriptions for one patient encounter will count as only one e-prescribing incident.

Find out more on the TMA 2013 E-Rx Penalty and Incentive Guidelines page. If you need help with e-prescribing, turn to the Texas regional extension centers (RECs). RECs provide support to help with e-prescribing, EHR selection, workflow analysis, staff training, EHR incentives, and much more. Visit TMA's Texas REC Resource Center for more information.

For questions about meaningful use or other HIT issues, contact TMA's HIT Department by telephone at (800) 880-5720 or by email, or visit the TMA EHR Incentive Program Resource Center  


Action, March 1, 2013


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