TMA, AMA Seek Delay in eRx Penalties

The government's plans to modify the 2011 electronic prescribing (eRx) incentive and 2012 eRx penalty program are welcome, but do not go far enough, TMA, American Medical Association, and more than 80 national specialty societies and state medical associations told the Centers for Medicare & Medicaid Services (CMS) in a July 25 letter [PDF] to CMS Administrator Donald Berwick, MD. 

They called for additional steps, "including establishing an additional eRx reporting period in 2012 and not applying penalties until 2013; otherwise, a significant number of physicians and other eligible professionals (EPs) will be unfairly penalized starting on January 1, 2012."

The groups asked for four additional exemption categories:

  1. The physician is registered to participate in the Medicare or Medicaid electronic health record (EHR) incentive programs and has adopted certified EHR technology.
  2. The physician is unable to e-prescribe because of local, state, or federal regulations.
  3. The physician prescribed fewer than 10 prescriptions between Jan. 1, 2011, and June 30, 2011.
  4. There are insufficient opportunities to report the eRx measure because of program limitations, e.g., a surgeon who does not frequently use permissible service codes.  

TMA signed the letter at the recommendation of the TMA Ad Hoc Committee on Health Information Technology. The committee emphasized that CMS should allow physicians to apply for an exemption if they met the e-prescribing program requirements but their claims submissions did not have the G8553 code due to administrative or system errors or the use of an older eRx G code rather than the G8553 code on their claims. TMA staff has heard of instances where vendors or clearinghouses inadvertently dropped the G-code that indicates a successful e-prescription.

CMS recently announced it would alter the e-prescribing measure for the 2011 incentive and 2012 penalty programs, and add additional "significant hardship" exemption categories for eligible professionals and group practices so they can request an exemption during 2011 to avoid the 2012 eRx payment adjustment.  It will extend the deadline for submitting requests for consideration of the two significant hardship exemptions for the 2012 eRx payment adjustment included in the 2011 Medicare Physician Fee Schedule final rule.

"We believe that these immediate steps to modify the eRx program are helpful," organized medicine's letter said. "However, it is important to keep in mind that requiring reporting the year before the penalty program starts, not creating adequate exemption categories, and last minute modifications create confusion and do not allow enough time to educate physicians on steps they need to take to avoid eRx penalties in 2012."

TMA will continue to monitor CMS activities and will alert Texas physicians once the final rule is published so that physicians can take appropriate steps, if eligible, to avoid eRx penalties. 

For questions about e-prescribing or other office technologies, visit the TMA website, call the TMA Health Information Technology helpline at (800) 880-5720, or email HIT.

Action, Aug. 1, 2011