Home > Medicare > If Necessary, Last Opportunity to Apply for Exemption from Medicare e-Prescribing Program

If Necessary, Last Opportunity to Apply for Exemption from Medicare e-Prescribing Program

The vast majority of ACR members are automatically exempt from the incentives and penalties for the Centers for Medicare and Medicaid Services’ (CMS) e-Prescribing (eRx) Incentive Program. In order to be subject to the eRx penalties, a physician would need to meet both of the following criteria, among others:

  1. 10% of the physician’s Medicare Part B PFS allowed charges must be comprised of the codes listed below, and
  2. The physician must have at least 100 cases containing one of the codes listed below.

90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, and G0109.

If you meet both criteria (or you are concerned you could possibly meet both criteria), you should consider applying for a significant hardship exemption before the November 1, 2011 deadline to avoid the 1% PFS payment reductions in 2012. To do this, simply use your IACS information to sign into the CMS Quality Reporting Communication Support page and follow the links to apply for the eRx hardship exemption.

The available exemption options are briefly listed below and are explained in the CMS final rule:

  • Eligible professionals who register to participate in the 2011 Medicare or Medicaid EHR Incentive Program (“meaningful use”) and adopt certified EHR technology.
  • Inability to electronically prescribe due to local, State, or Federal law or regulation (e.g., controlled substances).
  • Limited prescribing activity.
  • Insufficient opportunities to report the electronic prescribing measure due to limitations in the measure’s denominator (i.e., limitations with the aforementioned encounter codes).
  • The practice is located in a rural area without high-speed Internet access.
  • The practice is located in an area without sufficient available pharmacies for electronic prescribing.

Again, most ACR members do not need to take any further action, as they will not meet the aforementioned criteria and are therefore automatically exempted by CMS from the eRx penalties.

Additional Resources

NOTE: The eRx Incentive Program is unrelated to the EHR Incentive Program or “meaningful use,” with the exception of the associated hardship exemption.

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Categories: Medicare

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