Alert: eRx Hardship Exemption Requests Reopens November 1
Beginning Nov. 1 through Jan. 31, 2013 individual physicians and other eligible professionals and selected group practices can once again apply through the CMS online portal for a hardship exemption under the 2013 Medicare Electronic Prescribing (eRx) Incentive Program. See below for details on who should apply. For additional help applying online, see the CMS user guide and website.
APA Members may call 800.343.4671 or email email@example.com the Practice Management HelpLine for assistance.
More information on the Electronic Prescribing Program is available on the APA's website.
Medicare currently has an incentive program in place for physicians who do electronic prescribing (e-prescribing, or eRx), which means transmitting a prescription electronically directly to a pharmacy. In 2012 there is also a penalty system in place for physicians who failed to electronically prescribe beginning in 2011.
To participate in the incentive program just include the code G8553 when you fill out a claim for a Medicare beneficiary for whom you’ve e-prescribed. (In past years the prescribing had to be tied to specific denominator codes, but this is no longer the case.) A minimum of 25 claims with the G-code will earn you a .5% incentive in 2013 (the percentage is based on the value of your total Part B claims for the year). In 2013, based on the first six months of 2012 eRx activity, there is also a 1.5% penalty for those who did not e-prescribe during that period. In 2014 the incentive disappears, but a 2% penalty is in place.
There are three circumstances that automatically exempt you from the penalty:
- If you are not a physician as of June 30, 2012.
- If office visits and other services stipulated in the CMS e-prescribing measures accounted for less than 10% of your Medicare Part B charges in the first 6 months of 2012 (On the CMS page, click on the E-Prescribing Measure link on the left side of the page, and on the new page download the first zip file, which contains the 2012 eRx measure).
- If you have fewer than 100 Medicare claims for the denominator codes listed in the footnote below.
There are another six exemptions to this penalty that are not automatic and for which you must apply:
- for physicians who live in an area where there is no high speed internet access;
- for physicians who live in an area where there are not sufficient pharmacies that can receive electronic prescriptions;
- for physicians who delayed purchasing an e-prescribing system because of an intention to participate in Medicare’s electronic medical records incentive for 2011;
- for physicians who have limited prescribing activity;
- for physicians who live in an area where regulations prevent e-prescribing; such as those prohibiting paperless orders for controlled substances; and
- for physicians who e-prescribe but only for types of visits that don’t count toward the 10-order minimum (visits that aren’t included in the denominator codes).
CMS has said eligibility for the exemptions will be considered on a case-by-case basis as it was for 2012. You must apply for the 2013 exemption no later than June 30, 2012.
There is no exemption for small practices, as there is under Medicare for the requirement to file claims electronically. (However, if you have fewer than 100 encounters with Medicare patients in the first six months of 2012 using one of the denominator codes, the penalty will not apply to you.) Psychiatrists with small practices who see a large number of Medicare patients and wish to avoid the penalty should be aware that when they begin to e-prescribe they will become HIPAA covered entities.
In summary, if you don’t apply and qualify for one of the exemptions, don’t e-prescribe at least 10 times in the first six months of 2012, and did treat a significant number of Medicare patients under Part B, you will be hit with a 1.5% penalty on all of your Medicare claims for 2013.
CMS has posted complete information on how e-prescribing payment adjustment works.
E-prescribing can be accomplished either with freestanding software or it can be done using part of an electronic health records (EHR) system. An e-prescribing system is cheaper than an EHR system, and because of its more limited functionality is comparatively easier to learn how to use. However, it is important to take into account that as of 2015 there will be a Medicare payment reduction if physicians are not using an EHR system, and there is an incentive program for using EHR if you begin by October 2012 (although another factor to take into account is if you receive the EHR incentive you cannot also receive the eRx incentive).
What to Do
Unfortunately, there is no simple advice we can offer you on how to proceed in this confusing new world. Unless you are automatically excempt or qualify and apply for one of the six exemptions, you can't avoid the 1.5% penalty in 2013 if you don't have an e-prescribing software system in place well before the end of 2012.
Standalone eRx programs are generally less expensive and less complex than full EHR systems, but in purchasing this software, you run the risk of wasting time and money on a system that may become unnecessary if you put an EHR system in place for your practice. EHR technology is relatively new and the EHR market is still evolving. It’s not unreasonable to think that the cost and sophistication of EHR systems will be moving targets over the next few years.
For More Information
 90801, 90802, 90805-90809, 90862, 99201-99205, 99211-99215, 99304-99310, 99315, 99316, 99324-99328, 99334-99337, 99341-99343, 99345, 99347-99350, G0101, G0108, G0109