CMS Proposes Changes to eRx Incentive Program
Under the Electronic Prescribing (eRx) Incentive Program, the Centers for Medicare & Medicaid Services (CMS) will dole out incentives to successful electronic prescribers (e-prescribers), and penalize those who aren’t, beginning in 2012. On June 1, however, the agency published a proposed rule in the Federal Register that would give providers more reasons and more time to excuse themselves from the program without being penalized.
CMS proposes to modify the 2011 eRx quality measure used for certain reporting periods this year; permit eligible professionals (EPs) and group practices four additional categories they can report to exempt themselves from the 2012 eRx payment adjustment, and allow three additional months in which to do it.
Under the eRx Incentive Program, EPs (i.e., physicians, nurse practitioners, and physician assistants) who are successful e-prescribers can receive a 1 percent incentive payment for program years 2011 and 2012, and 0.5 percent for 2013. Unsuccessful e-prescribers, however, face adjustments to Medicare physician fee schedule (MPFS) payments beginning in 2012—1 percent in 2012, 1.5 in 2013, and 2 percent in 2014.
This latest proposed rule would:
- modify the 2011 eRx quality measure used for certain 2011 reporting periods to allow EPs and group practices to adopt a “qualified” eRx system (as defined in the 2011 Medicare Physician Fee Schedule (MPFS) final rule) or “certified” (as defined at 42 CFR 495.4 and 45 CFR 170.102) electronic health record (EHR) technology;
- provide additional significant hardship exemption categories for EPs and group practices to request an exemption during 2011 for the 2012 eRx payment adjustment; and
- extend the deadline to request consideration for all significant hardship exemption categories (including those that were finalized in the 2011 MPFS final rule) from June 30 to Oct. 1.
Current Reporting Requirements
In the 2011 MPFS final rule, CMS finalized two circumstances under which an EP or group practice can request consideration for a significant hardship exemption for the 2012 eRx payment adjustment:
1. The EP or group practice practices in a rural area with limited high-speed Internet access (G4862); or
2. The EP or group practice practices in an area with limited available pharmacies for eRx (G4863).
To request a significant hardship exemption from the 2012 eRx payment adjustment using one of these two significant hardship categories, the EP or group practice must report G4862 or G4863 at least one time on a claim between Jan. 1, 2011 and June 30, 2011.
Proposed Reporting Requirements
CMS is now proposing to add the following significant hardship exemption categories for the 2012 eRx payment adjustment with regard to the reporting period of Jan. 1 through June 30:
3. EPs who register to participate in the Medicare or Medicaid EHR Incentive Program and adopt certified EHR technology;
4. EPs unable to electronically prescribe due to local, state, or federal law or regulation;
5. EPs with limited prescribing activity; or
6. EPs who have insufficient opportunities to report the eRx measure due to limitations of the measure’s denominator.
Submissions of significant hardship exemption requests for the 2012 eRx payment adjustment may be made via a web-based tool (which has yet to be created) or a mailed letter.
EPs requesting one of the current significant hardship exemption categories via claims-based submission of a G-code will still have to do so prior to the current deadline of June 30. If the web-based tool is not developed prior to the publication of the final rule, then CMS will default to mail submission of all significant hardship exemption requests (including those for the current hardship exemption categories) postmarked no later than Oct. 1.
The comment period for this proposed rule closes July 25.