Avoid Medicare Payment Reduction for Not E-Prescribing

2011 Electronic Prescribing (eRx) Incentive Program Reminder - Avoiding the Adjustment

In November, the Centers for Medicare & Medicaid Services announced that, beginning in calendar year 2012, eligible professionals who are not successful electronic prescribers based on claims submitted between January 1, 2011, and June 30, 2011, may be subject to a payment adjustment on their Medicare Part B Physician Fee Schedule (PFS) covered professional services. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the eligible professional is planning to participate in the eRx Incentive Program. MSMS has joined with the AMA and other organizations to communicate with CMS several concerns about the way in which this is being implemented, and we will communicate any new developments as they become available.

The June 30, 2011, deadline is fast approaching to have your minimum amount of electronic prescriptions completed to avoid penalties by Medicare. If you have not started using an eligible ePrescribing (eRx) tool, MSMS Connect/AMAGINE™ can assist you in getting access to the tools you need to qualify for the Medicare eRx Incentive. There are multiple eRx solutions which a physician can easily implement and begin using in their practice. For questions and assistance, please contact Dara Barrera at djbarrera@msms.org or Stacey Hettiger at shettiger@msms.org.

From 2012 through 2014, the payment adjustment will increase each calendar year. In 2012, the payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice receiving 99% of their Medicare Part B PFS amount that would otherwise apply to such services. In 2013, an eligible professional or group practice will receive 98.5% of their Medicare Part B PFS covered professional services for not being a successful electronic prescriber in 2011 or as defined in a future regulation. In 2014, the payment adjustment for not being a successful electronic prescriber is 2%, resulting in an eligible professional or group practice receiving 98% of their Medicare Part B PFS covered professional services.

The payment adjustment does not apply if <10% of an eligible professional’s (or group practice’s) allowed charges for the January 1, 2011, through June 30, 2011, reporting period are comprised of codes in the denominator of the 2011 eRx measure.

Please note that earning an eRx incentive for 2011 will NOT necessarily exempt an eligible professional or group practice from the payment adjustment in 2012.

How to Avoid the 2012 eRx Payment Adjustment

Eligible Professionals – An eligible professional can avoid the 2012 eRx Payment if he or she:

Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of June 30, 2011, based on primary taxonomy code in NPPES
Does not have prescribing privileges. Note: He or she must report (G8644) at least one time on an eligible claim prior to June 30, 2011
Does not have at least 100 cases containing an encounter code in the measure denominator
Becomes a successful e-prescriber
Reports the eRx measure for at least 10 unique eRx events for patients in the denominator of the measure

Group Practices - For group practices that are participating in eRx GPRO I or GPRO II during 2011, the group practice MUST become a successful e-prescriber.

Depending on the group’s size, the group practice must report the eRx measure for 75-2,500 unique eRx events for patients in the denominator of the measure.

For additional information, please visit the “Getting Started” webpage at http://www.cms.gov/erxincentive on the CMS website; or download the Medicare’s Practical Guide to the Electronic Prescribing (eRx) Incentive Program under Educational Resources.

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