2011 eRx Incentive Final Rule Posted

The Electronic Prescribing (eRx) Incentive Program 2011 final rule has been posted by the Centers for Medicare & Medicaid Services (CMS). The rule fulfills requirements laid out in the Medicare Improvements for Patients and Providers Act (MIPPA) by defining what a provider must do to avoid the Medicare Physician Fee Schedule (MPFS) adjustment should he or she not adopt eRx. New “significant hardship” exemptions are intended to help physicians who are unable to adopt the program.

Under MIPPA, those who are not successfully using eRx beginning in 2012 will receive 1 percent less than outlined in the MPFS for their services. In 2013 they face a 1.5 percent reduction in payments. Those unable to successfully adopt eRx by 2014 will sustain a 2 percent hit. Methodology for identifying successful providers is based on the Physician Quality Reporting System (PQRS).

The rule defines what is an eligible professional (EP) or a group practice. New “significant hardship” exemptions are available to providers or practices who can demonstrate the following:

  • EPs who register to participate in the Medicare or Medicaid electronic health record (EHR) Incentive Program and adopt certified EHR technology;
  • Inability to adopt eRx due to local, state, or federal law or regulation;
  • Limited prescribing activity; or
  • Insufficient opportunities to report the eRx measure.

CMS says section 1848(a)(5)(B) of the act also provides for the secretary to exempt (on a case-by-case basis) an EP from the payment adjustment if the secretary determines (subject to annual renewal) that compliance with the requirement for being a successful e-prescriber would result in a significant hardship. In the MPFS 2011 final rule, CMS established two significant hardship exemptions in the form of G codes for purposes of the 2012 payment adjustment:

  • The EP practices in a rural area without sufficient high-speed Internet access (report code G8642 The eligible professional practices in a rural area without sufficient high-speed Internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a) (5) (A) of the Social Security Act).
  • The EP practices in an area without sufficient available pharmacies for eRx (report code G8643 The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the application of the payment adjustment under section 1848(a) (5) (A) of the Social Security Act).

To request consideration for an exemption from the 2012 payment adjustment via one of these significant hardship HCPCS Level II G codes, the EP must have reported the G code at least one time on a claim between Jan. 1, 2011 and June 30, 2011. A group practice participating in the eRx group practice reporting option for 2011 must have requested the significant hardship exemption at the time the practice self-nominated to participate.

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One Response to “2011 eRx Incentive Final Rule Posted”

  1. Marcia says:

    I work for a group of Interventiona Radiologists that don’t prescribe. Do they have to do anything like fill out the hardship form?

    Thanks Marcia

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