The Centers for Medicare & Medicaid Services (CMS) issued a Medicare Learning Network Matters release reminding those eligible professionals (EPs) who do not successfully e-prescribe in 2011 that they face potential penalties to their Medicare Part B Physician Fee Schedule (PFS) payments for covered professional services in 2012 (-1 percent) and 2013 (-1.5 percent).
Earning the e-prescribing incentive for 2011 will not necessarily exempt an EP or group practice from the penalty starting on Jan. 1, 2012. These 2012 penalties are based on an EP successfully e-prescribing for Medicare patients ten times in the first six months of 2011 using claims-based reporting. For 2013, penalties are based on whether the EP successfully e-prescribes for 25 Medicare patients during 2011. Even if the EP attests to being a meaningful user of their EHR in 2011 (a program that that includes an e-prescribing requirement), they must still submit a minimum of 10 e-prescriptions on claims by the end of June.
EPs can avoid the 2012 e-prescribing penalty if they:
Are not physicians (MDs, DOs, or podiatrists), nurse practitioners, or physician assistants as of Jun 30, 2011 based on their primary taxonomy code in the National Plan and Provider Enumeration System
Do not have prescribing privileges. Note: they must report (G8644) at least one time on an eligible claim prior to June 30, 2011
Do not have at least 100 Medicare cases containing an encounter code in the measure denominator.
If an EP or selected group practice wishes to request an exemption from the e-prescribing program and penalties, there are two “hardship codes” that can be reported via claims should one of the following situations apply:
G8642 - The EP practices in a rural area without sufficient high speed internet access and requests a hardship exemption from the penalty
G8643 - The EP practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the penalty
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
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