In the 2013 Medicare physician payment rule, the Centers for Medicare and Medicaid Services (CMS) approved two additional hardship exemptions that can be used by physicians to avoid e-prescribing reimbursement penalties in 2013.
Medicare’s e-prescribing program provides payment incentives for physicians who e-prescribe and payment penalties for physicians who do not. In 2013, Medicare will impose a 1.5 percent payment reduction penalty on all Medicare allowed charges for eligible professionals who were not successful e-prescribers for 2011, did not report e-prescribing activity using measure code G8553 for at least 10 eligible outpatient visits via claims submission in the first six months of 2012, or did not request an exemption. The penalty increases to 2 percent in 2014.
The two new exemption categories include physicians who:
- Demonstrated "meaningful use" of an EHR system during the previous e-prescribing period, which ran from Jan. 1, 2011 to June 30, 2012; or
- Register to participate in the Medicare or Medicaid EHR incentive programs by Jan. 31, 2013. (The EHR Certification Number must be in the EHR Certification Registration ID field to qualify.)
Until now, successful participation in the EHR program, which includes an electronic prescribing component, did not automatically exempt a physician from the e-prescribing penalty. This lack of alignment between the two programs has been a source of frustration for physicians.
The two new exemptions are automatic and physicians do not need to apply for a hardship exemption if they meet one of the two new criteria. CMS will automatically exempt these physicians from the 2013 payment penalty.
The new exemption categories are in addition to the four existing hardship conditions, which include physicians who:
- Were unable to e-prescribe because of certain laws or regulations (including prescribing large volumes of narcotics)
- Generated fewer than 100 prescriptions during a six-month reporting period
- Practice in an area with insufficient pharmacies with e-prescribing capabilities
- Practice in an area with limited access to high-speed Internet
CMS also announced late last month that it would be reopening the hardship reporting period to request an exemption from the 2013 e-prescribing penalty. Requests under the four previously existing hardship conditions can now be submitted until Jan. 31, 2013, and must be submitted via the CMS Quality Reporting Communication Support Page at www.qualitynet.org.
Contact: Michele Kelly, (213) 226-0338 or at firstname.lastname@example.org.