Last Call to Avoid Medicare Penalty

Physicians who have not e-prescribed at least 10 times by June 30 may be penalized (1 percent Medicare Part B) for the 2012 calendar year. The Centers for Medicare & Medicaid Services (CMS) estimates 209,000 physicians and other providers will be penalized.

The penalty increases to 1.5 percent in 2013 for physicians who do not submit 25 e-prescriptions by Dec. 31. Submitting 25 e-prescriptions by Dec. 31 may also qualify you for a 1 percent bonus. (See TMA's 2011 e-prescribing white paper [PDF]).

Have You Not Started E-Prescribing?
Perhaps you're planning on e-prescribing when you purchase an electronic health record (EHR) system, but with only 15 days left until the June 30 deadline, it won't be implemented soon enough!

Other e-prescribing options are available.  Follow these steps:  

  1. Select an e-prescribing system. Many Texas physicians are going with standalone systems such as Dr. First by Rcopia and RxNT, priced around $50 per month per physician. A free vendor-sponsored, ad-supported e-prescribing system also is available through the National ePrescribing Patient Safety Initiative. All of these systems meet CMS qualification standards.
  2. Select your hardware.  To install or access a standalone e-prescribing system, you need a computer with an Internet connection.
  3. Send 10 e-prescriptions. The June 30 deadline requires you to send 10 new e-prescriptions for 10 of your Medicare patients. (See TMA's 2011 e-prescribing white paper [PDF]).
  4. Report G-code G8553 to Medicare. There is no separate application for the Medicare e-prescribing program; simply report G8553 on your Medicare claim and submit the G-code again with every office visit during which an e-prescription is sent.

10 E-Prescriptions in a Crunch
If you're in a rush to beat the June 30 deadline, you're not alone. Here is what you need to know about Medicare's e-prescribing program:  

  1. CMS counts a successful e-prescription as an "event" as soon as a physician sends an e-prescription to a pharmacy.
  2. The event counts even if a pharmacy is not capable of accepting e-prescriptions or rejects the e-prescription. (Standalone e-prescribing systems automatically convert to fax if a pharmacy is not capable of receiving e-prescriptions.)
  3. Whether a patient picks up his or her prescription is not relevant to a successful event.
  4. A successful event can include over-the-counter prescriptions for vitamins, stool softeners, and Tylenol 3 or other noncontrolled pain relievers.

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 of $44,000 to $63,750 under Medicare and Medicaid. Visit the TMA REC Resource Center for more information.

Program Exemptions
TMA urged CMS to revise the current e-prescribing penalties, and CMS announced in May proposed changes to the 2011 e-prescribing program by adding possible exemptions for the 2012 penalty. TMA will comment on the proposed rule, again urging CMS to adopt the additional exemptions. The final ruling on additional exemptions is expected by September. Existing program exemptions can be reported now by using a G-code on Medicare claims, including:

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

If you have additional questions about program e-prescribing or program exemptions, email or call the TMA HIT helpline at (800) 880-5720.

 Action, June 15, 2011  

Last Updated On

February 20, 2012