Did You Get an E-Prescribing Penalty?

Some physicians have picked up a 1-percent Medicare penalty this year 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 took 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 reported on at least 10 successful e-prescriptions before June 30 by adding G8553 to the claim form or 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 from 7 am through 7 pm Monday through Friday to have your case examined. The number is (866) 288-8912, or you can email qnetsupport@sdps.org.

An American Medical Association advisory says it received reports of physicians being turned away when calling the help desk, but says CMS has worked to make sure it adequately reviews physician's cases. There is no formal appeals process, but CMS encourages physicians with questions or concerns about their penalty and/or or hardship exemption request to contact the help desk, AMA says. CMS will handle requests for exemptions case by case. Physicians who still have problems with the help desk may email their concerns directly to Medicare at eRx_hardship@cms.hhs.gov.

June 30, 2012, is the deadline to submit and report e-prescribing for at least 10 Medicare patients to prevent a 1.5-percent Medicare penalty in 2013. Dec. 31, 2012, is the deadline for e-prescribing for at least 25 Medicare patients to earn a 1-percent incentive on all 2012 Medicare allowable charges. Details and instructions on the Medicare e-prescribing program are available here. For more information, contact TMA's Health Information Technology Department by telephone at (800) 880-5720 or by email.

Action, April 3, 2012