By Kathleen Gaffney
Take advantage of extended deadline and expanded significant hardship exemption categories
The Centers for Medicare & Medicaid Services (CMS) just released the final rule for changes to the 2011 Medicare Electronic Prescribing (eRx) Incentive Program that will be effective on October 6, 2011. Last year the CMS announced that beginning in 2012, eligible professionals (EP) who are not successful electronic prescribers may be subject to a payment adjustment. The payment adjustment in 2012, with regard to all of the EPs’ Part B-covered professional services, will result in the EP or group practice receiving 99% of the physician fee schedule amount, which would otherwise apply to such services.
The CMS estimates that there are approximately 209,000 EPs subject to the 2012 eRx payment adjustment unless they become a successful electronic prescriber or receive a significant hardship exemption. In order to apply for the significant hardship, an EP must meet one of the two significant hardship exemptions established that were previously finalized in the CY 2011 PFS final rule with the comment period, or one of the four additional significant hardship exemption categories being finalized for the 2012 eRx payment adjustment.
The significant hardship exemptions established previously are:
The EP practices in a rural area without sufficient high-speed internet access
The EP practices in an area without sufficient available pharmacies for electronic prescribing
EPs who wish to request a hardship exemption for either two categories above will not be able to do so via claims-based submission of a G-code, as the June 30, 2011 deadline for doing so has passed. Instead, the EP must submit a request for a significant hardship exemption via letter postmarked no later than November 1, 2011.
The additional significant hardship exemption categories to be finalized for the 2012 eRx payment adjustment include:
1. EPs who register to participate in the Medicare or Medicaid EHR incentive program and adopt, implement or upgrade to certified EHR technology by October 1, 2011.
This exemption does two key things for the EP. First, it removes the ambiguity as to whether the certified EHR technology that the EP has adopted for the EHR incentive program can be used to meet the eRx quality measure under the eRx incentive program. Second, it provides the EP who is eligible for incentives under the Medicaid EHR incentive program with extended time to submit a request for exemption.
EPs who have not yet taken steps to participate in the Medicare or Medicaid EHR incentive programs will not qualify for the hardship, as all requirements to qualify for an exemption under this category must be met by October 1, 2011 and prior to the time the EP requests an exemption. To qualify for the exemption under this category, an EP must have registered for either the Medicare or Medicaid EHR incentive program, adopted a certified EHR technology for use and provide CMS with EMR-identifying information which can be generated through the Certified HIT Products List (CHPL) website no later than October 1, 2011. CMS is no longer requiring EPs to provide their product's serial number.
While Medicare EPs and group practices cannot earn an incentive under both the eRx incentive program and the EHR incentive program for the same year, EPs will be subject to an eRx payment adjustment if they do not meet the requirements under the eRx incentive program. It is not necessary that an EP receive an incentive payment under the Medicare or Medicaid EHR incentive program to qualify for an exemption to the 2012 eRx payment adjustment under this significant hardship exemption category.
2. EPs with prescribing authority that is limited to the extent that local, state, or federal law or regulation limits or prevents an EP/group practice that otherwise has general prescribing authority from electronically prescribing.
This includes EPs who prescribe a large narcotics volume such as surgeons, neuro-ophthalmologists, radio-oncologists and orthopedic doctors, which may not be electronically prescribed in some states. Also included are EPs who practice in a state that prohibits or limits the electronic prescriptions transmission via a third-party network such as SureScripts.
3. EPs or group practices who have prescribing privileges but do not prescribe, or very infrequently prescribe in practice, but still meet the 10-percent threshold for applicability of the payment adjustment.
For example, a nurse practitioner who may not write prescriptions under his or her own NPI, a provider who prescribes durable equipment, a physician who let their drug enforcement administration registration lapse, or an EP who prescribed fewer than 10 prescriptions between January 1, 2011 and June 30, 2011, regardless if the prescriptions were electronically prescribed.
4. EPs who electronically prescribe, but have insufficient opportunities to report the eRx measure due to limitations of the measure's denominator, which only accounts for certain patient encounters.
This exemption category is intended for EPs who provide electronic prescriptions on a day different from the beneficiary's visit such as an EP that provides a prescription during a post-operative visit.
New Deadlines and Process
The final rule provides deadline extension for submitting requests for exemptions to November 1, 2011. EPs and group practices do not need to wait until the effective date of this final rule to submit a request for an exemption from the 2012 eRx payment adjustment. CMS estimates that the application for exemption should not take more than two hours per EP or group practice to complete. All exemption requests will be on a case-by-case basis.
For additional information about the electronic prescribing (eRx) incentive program and instructions on how to access the web-based tool and request an exemption will be available on the eRx incentive program website at http://www.cms.gov/ERxIncentive/ or by contacting Hayes Management Consulting.