Wiki E Rx Penalty from Medicare

[mmpratt]

Just wondering if other orthopedic practices are getting dinged with a penalty from Medicare for the electronic Rx. We submitted our exception paper under our group NPI and are consistently receiving an additional reduction in payment for N545 (I don't have a Medicare RA in front of me so think this is the correct code).

When trying to work with the contractor for Noridian as to why we continue to get dinged even though we filed our exception paperwork, we're getting the runaround that we should have filed for each physician with his/her NPI.

Anyone have a similar situation or a success story to share? Thanks.

 

[jeanace]

Unfortunately, your MAC is correct. the eRx penalty is provider specific so any hardship exemption filed in 2011 should have been under each physician's NPI.

 

[melzinser]

each provider separately

Yes, it is each provider separately.

My 22 doc ortho practice found the online process easy enough and very successful.

We submitted a hardship exemption request specific to each provider's rationale, eg, prescribing mostly narcotics for the pain management docs or no denominator code during post-op visits for our surgeons. We received individual confirmations that the hardship exemption was granted. We have three docs we felt did not fit any exemption category and we will take the ding on them.

Of course, they changed the exemptions again, but I believe they are still "per provider".