Action Special Issue: Oct. 26, 2011

TMA Action, Oct. 26, 2011
News and Insights from
Texas Medical Association  

SPECIAL ISSUE: Get E-Prescribing Exemption by Nov. 1 

Physicians have until Nov. 1 to ask for an exemption from a 1-percent cut in Medicare payments next year  for not meeting Medicare's e-prescribing requirements this year. You must submit the online hardship exemption form by then.

The Centers for Medicare & Medicaid Services (CMS) will not accept letters or faxes; you must apply online. Some TMA members have reported problems accessing the exemption form. You may need to update your web browser to the latest version.

You may request an exemption if you:

  • Are registered to participate in the Medicare or Medicaid Electronic Health Record (EHR) Incentive Program, have adopted certified EHR technology, and intend to qualify for an incentive for payment year 2011;
  • Are unable to electronically prescribe due to local, state, or federal law or regulation (e.g., you prescribe controlled substances);
  • Infrequently prescribe (e.g., wrote fewer than 10 prescriptions between Jan. 1, and June 30);
  • Practice in a rural area without high-speed Internet access;
  • Practice in an area without enough pharmacies for electronic prescribing; or
  • Have too few opportunities to report the e-prescribing measure because of the limitations of the program. For example, you do e-prescribe but your electronic prescriptions are not related to the program's qualifying visits/services.

When you submit your exemption request, remember:

  • The "requestor" must be the physician applying for the exemption. Select "Health Care Provider" when indicating the "Requestor Relationship."
  • You must include a statement of justification that outlines how complying with the e-prescribing program caused a significant hardship.
  • If you can attest to more than one exemption, indicate this in the justification statement.

For more information about reporting an exemption, see the CMS e-prescribing exemption instruction guide [PDF]. CMS created the exemptions largely as a result of the concerns expressed by physicians across the country. The Texas Medical Association, for example, urged CMS to revise the e-prescribing penalties.

You are automatically exempt from the 2012 e-prescribing penalty if:

  • You submitted fewer than 100 denominator eligible claims to Medicare. (See TMA's 2011 E-Prescribing White Paper [PDF] to view eligible denominator codes.)
  • Less than 10 percent of your allowed charges from Jan. 1 through June 30 comprise denominator eligible codes.

If you are unsure if you are subject to the penalty or unsure if you successfully sent 10 e-prescriptions by the June 30 deadline, TMA recommends you review the exemptions and apply if one pertains to your hardship.

Receive a 1-Percent Medicare Incentive for 2011 

You still have time to receive a 1-percent Medicare bonus by successfully e-prescribing 25 prescriptions (and report each on a claim form with G-code G8553) by Dec. 31. Writing 25 e-prescriptions by Dec. 31 also prevents a 2013 e-prescribing penalty. Details on the e-prescribing program are available in TMA's 2011 E-Prescribing informational paper [PDF]. Email or call the TMA HIT helpline at (800) 880-5720 for more information.

If you need help with e-prescribing, turn to the Texas regional extension centers (RECs). RECs provide support to primary care physicians to help with e-prescribing, EHR selection, workflow analysis, staff training, EHR incentives, and much more. At a cost of $300 per eligible physician, you can get a consultant on site at any location in Texas. Visit TMA's Texas REC Resource Center for more information.


Any physician in business for more than a few months knows how difficult it is to work on the business. Between keeping pace with caring for patients, insurance company demands, government regulations, and the latest medical technology, there are never enough hours in a day. That's why TMA developed the Calendar of Doom, a web-based regulatory compliance tool giving you and your staff a big-picture view of upcoming state and federal compliance timelines and key health policy issues that impact Texas physicians.


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