Receiving Your ePrescribing Penalty in Error?

If your Medicare payments are being reduced by the Centers for Medicare & Medicaid (CMS) ePrescribing penalty, the agency may reconsider cases whose providers feel they were penalized in error. New regulations went into effect this year.

The 1 percent reduction resulting from the penalty for physicians not ePrescribing prompted the American Medical Association (AMA) to request a second look at the law, the organization says. The loop hole not only applies to errors, but to providers who applied for a hardship exemption.

The AMA says common scenarios allowing you to avoid the penalty include:

  • You ePrescribed in 2011, but HCPCS Level II code G8533 Participation by a physician or other clinician in systematic clinical database registry that includes consensus-endorsed quality measures was removed from the claims you submitted to Medicare. (For example, your billing vendor or clearinghouse mistakenly removed the code.) You must have documentation of your ePrescribing activity.
  • You reported the wrong G code on your claims. (For instance, you used a 2009 ePrescribing code instead of the 2011 code.) You must have documentation of your ePrescribing activity.
  • Your hardship exemption request was denied because you included your group National Provider Identifier (NPI) rather than your individual NPI.
  • You filed a hardship exemption request, but did not receive a response from CMS.

Other hardships may qualify you to receive an exemption to the penalty. Call CMS’ Quality Net Help Desk at (866) 288-8912 or send an email to present your case.

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5 Responses to “Receiving Your ePrescribing Penalty in Error?”

  1. carla says:

    Nope, I just called the help desk and was told even though CMS did not get our G-codes there is nothing they can do, so we are stuck with the 1% penalty even though we did it.

  2. Pam says:

    Isn’t the code G8553 instead of G8533 as published above?

  3. Doris says:

    I work for an osteopath that does not write very many rx’s, he is the only provider and the office is non EMR; when I called the help desk I was told that there were “no” exceptions. I would think that this would constitute as a hardship exception.

  4. Sue says:

    I called the help desk and was told that I can be rest assured – I am in a pool of 10’s of thousands of other physicians who received this penalty due to the fact that CMS’ hardship exemption form was misleading and did not properly outline that we had to fill out the individual’s NPI # when everything else had to be the group information! I was told that there is nothing I can do but I should be happy to know that the fixed their form for this year!! Does this make me happy? No! It infuriates me that they know there was an error on their form and they still take the 1% – isn’t that the reason we link up the individual NPI #’s to our group #?? Someone help me to understand!! I contacted our local Medical Society and was told that the AMA is doing everything in their power to make CMS retracte this penalty. **a posting nightmare!!** Yeah. I feel assured with how the government can giveth or taketh as they see fit! How about you?

  5. SHARON says:

    I AM MAGICALLY GETTING MY 1% BACK I HAD FILED AN EXEMPTION FOR TWO OF MY DOCS (SURGEONS WHO JUST DON’T WRITE THAT MANY RX’S) REC’VD ACKNOWLEDGEMENT FOR ONE OF THEM AND NOT THE OTHER. IT IS A POSTING NIGHTMARE!! NOT SURE IT IS WORTH IT AT THIS POINT.

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