E-prescribing Penalties and Incentives

Texas physicians have until June 30 to e-prescribe to avoid a 1.5-percent penalty on all 2013 Medicare Part B claims. If you do not already e-prescribe in your office, now is the time to begin. If you do not already use an electronic health record (EHR) system with e-prescribing capabilities, you can install a stand-alone e-prescribing system and still meet the approaching deadline.

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. Three prescriptions for one patient encounter will count as only one e-prescribing incident.

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 2014). Follow the instructions in TMA's 2012 e-prescribing informational paper [PDF], email, or call the TMA HIT helpline for more information at (800) 880-5720.

If you need help with e-prescribing, turn to the Texas regional extension centers (RECs). RECs provide support to physicians to help with e-prescribing, EHR selection, workflow analysis, staff training, EHR incentives, and much more. Visit TMA's Texas REC Resource Center for more information.

The Centers for Medicare & Medicaid Services (CMS) has offered the e-prescribing incentive since 2009 to encourage the use of e-prescribing to improve the efficiency and safety of health care. E-prescribing is a way to prevent medication errors that arise due to difficulties in reading or understanding handwritten prescriptions.

If you plan to apply for the Medicare EHR incentive in 2012, note that you can't receive the e-prescribing incentive in the same payment year. Physicians enrolled in the federal Medicare EHR incentive program can still be penalized in 2013 if they do not report 10 e-prescriptions via claims using G-code G8553. Physicians applying for the Medicaid EHR incentive are still eligible for e-prescribing incentive payments.

2012 Penalty
Physicians who did not e-prescribe and report the G-code at least 10 times by June 30, 2011, or did not apply for and receive an exemption are currently being penalized 1-percent of their Medicare Part B claims. Physicians who act this year will be made whole in 2013. There is no formal appeal or informal review process for the 2012 penalties. Physicians may submit all inquiries to the QualityNet Help Desk for CMS examination. Physicians may contact the Help Desk via telephone at (866) 288-8912 [TTY (877) 715-6222] from 7 am to 7 pm Monday through Friday, or via email at qnetsupport[at]sdps[dot]org.

Action, March 15, 2012

Last Updated On

April 18, 2012