E-prescribe by June 30 or Suffer Penalty

 Physicians now have until July 2 at 10:59 pm (CT) to apply for the e-prescribing hardship exemption to prevent a 1.5-percent penalty in 2013 on Medicare allowable charges. The extended deadline is due to scheduled maintenance on the web page where physicians must go to apply for the exemption.

Three prescriptions for one patient encounter count as only one e-prescribing incident. Reporting the G-code still is necessary even if you participate in the electronic health record (EHR) incentive program.   

You are automatically exempt from the 2013 e-prescribing penalty if:  

  • You submitted at least 25 e-prescriptions in 2011; 
  • You submitted fewer than 100 denominator-eligible* claims to Medicare in 2012; or  
  • Less than 10 percent of your allowed charges between Jan. 1, 2012, and June 30, 2012, consist of denominator eligible codes.*  

 *See page 2 of TMA's 2012 e-prescribing informational paper.  

You may log on to the Centers for Medicare & Medicaid Services (CMS) Communication Support Page and attest that you are eligible for one or more of the following exemptions:  

  • You cannot electronically prescribe due to local, state, or federal law or regulation (e.g., you prescribe controlled substances).  
  • You infrequently prescribe (e.g., fewer than 100 prescriptions between Jan. 1 and June 30). 
  • Your practice is in a rural area without high-speed Internet access. 
  • Your practice is in an area without sufficient available pharmacies for electronic prescribing.  

To access the exemption request form, visit the CMS Communication Support Page. 

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 may receive a 1-percent bonus on 2012 Medicare Part B claims (and prevent the 2-percent penalty in 2014) by e-prescribing and reporting G-code G-8553 on 25 claim forms for 25 unique Medicare patient visits by Dec. 31, 2012. Follow the instructions in TMA's 2012 e-prescribing informational paper, or e-mail 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. 

CMS has offered the e-prescribing incentive since 2009 to encourage 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 cannot receive the e-prescribing incentive in the same payment year. CMS can still penalize physicians enrolled in the federal Medicare EHR incentive program 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 penalized 1 percent of their Medicare Part B claims. Physicians who act this year will not  receive a penalty in 2013. There is no formal appeal or informal review process for the 2012 penalties. You may submit all inquiries to the QualityNet Help Desk for CMS examination. You may contact the Help Desk by telephone at (866) 288-8912 (TTY [877] 715-6222) from 7 am to 7 pm, Monday through Friday, or by email.  

Action, June 4, 2012