E-Prescribing Update: File for Hardship Exemption by June 30 to Avoid Penalties

March 28, 2012 12:35 am News Staff

Physicians who provide health care services to Medicare beneficiaries but who are not yet successfully prescribing electronically have until June 30 to request a significant hardship exemption(www.qualitynet.org) that would exclude them from the 2013 penalty related to CMS' electronic prescribing (e-prescribing) incentive program.

In a recent edition of MLN Matters(www.cms.gov), CMS reiterated that it could exempt individual eligible physicians and group practices from the 2013 payment adjustment "if it is determined that compliance with the requirement for being a successful electronic prescriber would result in a significant hardship."

Physicians can apply for a hardship exemption if they

  • are unable to e-prescribe because of local, state or federal regulations;
  • experience limited prescribing activity;
  • have insufficient opportunity in their practice setting to use the required CPT codes;
  • practice in rural areas with limited high-speed Internet access; or
  • work in areas where few pharmacies have implemented e-prescribing.

Steven Waldren, M.D., director of the AAFP's Center for Health IT, noted that physicians who were not able to demonstrate their e-prescribing capabilities by June 2011 already are experiencing a 1 percent reduction in their 2012 Medicare payments.

To avoid receiving the 2013 penalty -- a 1.5 decrease in Medicare payment -- physicians have until June 30 to either request an exemption or report the "G" 8553 code signifying e-prescribing for at least 10 billable Medicare Part B services provided between Jan. 1, 2012, and June 30, 2012.

"For each penalty year, physicians must demonstrate that they are e-prescribing by June 30 of the prior year," said Waldren.

He encouraged family physicians who qualify for a hardship exemption to apply for one in a timely manner. However, he also urged physicians who have the capacity to e-prescribe to give the technology a try.

"The Academy has gotten good feedback from members about the benefits of e-prescribing," said Waldren. For example, family physicians who prescribe electronically appreciate the speed and safety the technology provides.

Waldren pointed out that physicians still have plenty of time to embrace e-prescribing and prevent a reduction in their Medicare payments in 2014, when the penalty assessed will equal a 2 percent pay cut for covered Medicare professional services.

Although there is no formal appeal or review process for physicians who have been assessed the e-prescribing penalty in 2012, CMS urges physicians with questions about their individual situations to e-mail the QualityNet Help Desk or call (866) 288-8912 Monday through Friday from 7 a.m. to 7 p.m. CDT.

According to CMS sources, all questions about e-prescribing penalty payment adjustments and hardship exemption decisions will be handled on a case-by-case basis.