CMS Proposes New E-Prescribing Exemptions

The Centers for Medicare & Medicaid Services (CMS) announced proposed changes to the 2011 e-prescribing program [PDF] by adding exemptions for the 2012 penalty. Texas physicians still have until June 30 to e-prescribe to avoid penalties in 2012 (1 percent of Medicare Part B claims). If you have not started, you should.

Physicians must report e-prescribing via claims using G-code G8553 on at least 10 unique Medicare encounters by June 30 to prevent the penalty. Report at least 25 times by Dec. 31 to qualify for a 1-percent bonus of Medicare Part B claims and prevent the penalty in 2013. Follow the instructions in TMA's 2011 E-Prescribing informational paper [PDF], or email or call the TMA HIT helpline for more information at (800) 880-5720.

Physicians will have an opportunity to attest through an online web portal (CMS has not yet created the URL) by Oct. 1 that they should be eligible for one of the following exemptions to avoid the 2012 e-prescribing penalty:    

  • Physician is registered to participate in the Medicare or Medicaid Electronic Health Record (EHR) Incentive Program and has adopted certified EHR technology. 
  • 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 prescribes 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.  

Existing program exemptions can be reported now using a G-code on Medicare claims, including:

  • G8642: Physician's practice is in a rural area without high-speed Iinternet access; and
  • G8643: Physician's practice is in an area without sufficient available pharmacies for electronic prescribing.

These changes are largely a result of the concerns expressed by physicians across the country. TMA urged CMS to revise the current e-prescribing penalties. TMA will comment on the proposed rule urging CMS to adopt the additional exemptions.  

Looking for on-site help with e-prescribing? If you are a primary care physician, you may qualify for assistance through a federal grant for technical consulting services for only $300. Specialists interested in receiving services should contact their regional extension center (REC) for pricing information. The Texas RECs provide consulting help with programs like e-prescribing, selecting and implementing EHRs, and reaching meaningful use to earn federal EHR incentives up to $44,000-$63,750 under Medicare and Medicaid. Visit the TMA REC Resource Center for more information.

Action, June 1, 2011