Penalized for Not E-Prescribing in 2011?

TMA is getting calls from physicians who were penalized 1 percent for not e-prescribing in 2011, even though they thought they did everything correctly.

To prevent a 2012 penalty, physicians should have successfully e-prescribed 10 times and reported G8553 on the claim form before June 30, 2011. Physicians also could have filed for an exemption with the Centers for Medicare & Medicaid Services (CMS) before Nov. 7, 2011. 

Some physicians did take the required action but CMS penalized them anyway. If you are one of them, here are two possible reasons:  

  • Some practice management software requires a value in the "Charges" column of the claim form for each line item. If a value was not entered with the G-code, the software may not have submitted that line item to CMS. This would have caused a penalty because CMS did not receive information indicating successful e-prescribing. Check with your practice management software vendor, and check the claim submission forms to be sure the line item successfully transmits.  
  • Physicians participating in the Medicare Electronic Health Record (EHR) Incentive Program cannot receive the e-prescribing and EHR incentives in the same payment year. In this case, however, they should have done one of two things to prevent the penalty:  
    1. Reported on at least 10 successful e-prescriptions before June 30 by adding G8553 to the claim form, or  
    2. Applied for the exemption that indicates participation in the Medicare EHR Incentive Program in payment year 2011. The deadline to submit an exemption was Nov. 7, and you had to have registered for the EHR incentive program by Oct. 1, 2011.

If you think CMS penalized you wrongfully, contact the QualityNet Helpdesk to have your case examined. Call (866) 288-8912 or email qnetsupport[at]sdps[dot]org. 

The American Medical Association says CMS is notifying physicians whether it has approved their request for a hardship exemption from the 2012 penalty. AMA says CMS will email physicians.

Also, be aware that some supplemental insurance companies are not accepting claims that have the 2012 e-prescribing penalty code. You may receive a letter that says, "The claim(s) noted below was/were not crossed over due to claim errors and was/were rejected by the supplemental insurer." According to TrailBlazer Health Enterprises, the Medicare contractor for Texas, you should resubmit the claim to the supplemental insurance company. You also should ask the supplemental insurance company to add the code to its acceptance codes.

Physicians needing help with e-prescribing or the Medicaid or Medicare EHR incentive programs can turn to the Texas regional extension centers (RECs). All four RECs provide low-cost consulting to primary care physicians, thanks to federal grants to offset the cost. Visit the Texas REC Resource Center on the TMA website.

If you have questions about health information technology (HIT), contact the TMA HIT Helpline by telephone at (800) 880-5720 or by email

AMA has produced a fact sheet [PDF] on the basics of the Medicare electronic prescribing program.

Action, Feb. 15, 2012  

Last Updated On

February 14, 2012