CMS to Adjust eRx Payments

The Centers for Medicare & Medicaid Services (CMS) is warning providers participating in the 2012 e-Prescribing (eRx) Group Practice Reporting Option (GPRO) incentive program of Medicare Physician Fee Schedule (MPFS) payment adjustments through 2014. Individual eligible providers who are not successful electronic prescribers can avoid the 2013-2014 payment adjustments by meeting reporting requirements during a specified reporting period.

The applicable electronic prescribing percent for payment adjustments under the eRx Incentive Program are:

  • 1.0 percent adjustment in 2012 (eligible professionals will receive 99 percent of their MPFS amount that would otherwise apply to such services);
  • 1.5 percent adjustment in 2013 (eligible professionals will receive 98.5 percent of their MPFS amount for covered professional services); and
  • 2.0 percent adjustment in 2014 (eligible professionals will receive 98 percent of their MPFS amount for covered professional services).

CMS will exempt providers from the 2013 payment adjustment if compliance as a successful prescriber might result in a significant hardship:

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  • Inability to electronically prescribe due to local, state, or federal law;
  • The eligible professional prescribes fewer than 100 prescriptions during a 6–month payment adjustment reporting period;
  • The eligible professional practices in a rural area without sufficient high-speed Internet access (G8642); and
  • The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing (G8643).

Information about the new adjustments, how to avoid them, and how to apply for an exemption can be found on the CMS website.

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