2013 E-Rx Penalty and Incentive Guidelines

You have until June 30 to avoid a 2-percent penalty on all 2014 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.

You 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 0.5-percent bonus of Medicare Part B claims (and prevent the penalty in 2015). Follow the instructions in TMA's 2013 e-prescribing informational paper. 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 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) began the e-prescribing incentive in 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 2013, note that you can't receive the e-prescribing incentive in the same payment year. Physicians applying for the Medicaid EHR incentive are still eligible for e-prescribing incentive payments.

2012 Penalty
If you did not e-prescribe and report the G-code at least 10 times by June 30, 2012, or did not apply for and receive an exemption, you are penalized 1.5-percent of your Medicare Part B claims. Physicians who act this year will be made whole in 2014. There is no formal appeal or informal review process for the 2013 penalties. A new exemption is available for physicians who use a certified EHR and either register or attest for the meaningful use EHR incentive program by June 30. 

You may submit all inquiries to the QualityNet Help Desk for CMS examination. You may contact the help desk via telephone at (866) 288-8912 [TTY (877) 715-6222] from 7 am to 7 pm CST Monday through Friday, or via email.

Action, Feb. 1, 2013  

Last Updated On

February 06, 2013