California physicians are reporting that the Medicare payments they are receiving in 2012 have been reduced for a failure to prescribe enough electronically in 2011—despite the fact that these physicians have filed hardship applications to the Centers for Medicare & Medicaid Services (CMS). CMS responded to CMA inquiries that it was not able to process all hardship applications prior to January 1, although the agency says it has since approved or denied all of those exemption requests. This means that CMS has levied a 1 percent penalty for what it considers “noncompliant physicians.”
CMA is working with CMS to build clarity over whether penalties will apply to physician reimbursement rates going forward, and to ease confusion over the process in the future. For now, there is no official appeals process for the e-prescribing penalty program. However, CMS has expressed a willingness to work with individual physicians on concerns with the payment adjustments.
CMS encourages physicians who think they are receiving the e-prescribing penalty in error to contact its help desk. The QualityNet Help Desk can be reached by phone Monday through Friday, 7 am to 7 pm CST at (866) 288-8912 or by email at firstname.lastname@example.org.
Avoid the 2013 penalty
On March 1, the agency reopened its hardship requests from physicians looking to avoid the 2013 e-prescribing penalty, which will grow to 1.5 percent. Physicians seeking waivers will have until June 30 to file exemption requests. A request for a feedback report, and an application for a hardship exemption, can be filed online by clicking on the Communications Support Page.
CMS will host a National Provider Call on the Physician Quality Reporting System & Electronic Prescribing Incentive Program. Experts will provide an overview on claims-based reporting for both programs, followed by a question and answer session.
The call is scheduled for Tuesday, February 21, from 10:30 am to 12 pm Pacific Standard Time.
All Medicare Fee-For-Service providers, medical coders, physician office staff, provider billing staff, electronic health records staff, and vendors are encouraged to participate in this call.
Click here to register for the call. Please note the presentation for this call will be posted at least one day in advance http://www.CMS.gov/PQRS/04_CMSSponsoredCalls.asp in the “Downloads” section of the page.
The percentage of California physicians who electronically prescribe medications has increased steadily over the last few years, according to a report from Cal eConnect, the agency that oversees health information exchange in California.
The report found that about 25% of California’s physicians currently e-prescribe, up from 3% in 2007. However, the report notes that only about 16% of eligible prescriptions are sent electronically, even though most California pharmacies are set up to receive e-prescriptions.
Source: California Healthline, February 9, 2012.
The American Recovery and Reinvestment Act of 2009 established the Electronic Health Record (EHR) Incentive Program for Medicaid and Medicare providers. Beginning in 2011, eligible Medi-Cal professionals and hospitals will be able to receive incentive payments to assist in purchasing, installing, and using electronic health records in their practices.
Effective 11/15/2011, California has opened registration for groups and clinics. Group/clinic representatives can register their group/clinic(s) in the State Level Registry. Provider registration is scheduled to begin on 12/15/2011.
Program Eligibility for Professionals
Professionals must not be hospital-based (may not perform 90 percent or more of their services in a hospital inpatient or emergency room setting) and must meet at least one of the following criteria:
- Have a minimum 30 percent Medicaid patient volume
- Have a minimum 20 percent Medicaid patient volume if they are a pediatrician
- Practice predominantly in a FQHC or RHC and have a minimum 30 percent patient volume attributable to needy individuals
Providers can review the EHR Incentive Programs: Medicaid Eligible Professional page on the CMS website for more information.
Click here to learn more about this incentive program or consider registering for the November 30, 2011 complimentary webinar hosted by SFMS/CMA. Register at www.cmanet.org/events.
CMS has extended the deadline to apply for Medicare e-prescribing hardship exemption to Tuesday, November 8, 2011. Click here to file for a hardship exemption.
Troubleshooting problems accessing the hardship exemption webpage
After reaching the hardship extension website, select Tools, then Internet Options, then Advanced in your internet browser. Scroll down toward the bottom and locate the “Use TLS 1.0” option. Place a checkmark next to “Use TLS 1.0.” Click OK. Attempt to access the site again.
If you still have trouble accessing the site, the QualityNet Help Desk may be reached at (866) 288-8912 or by email at email@example.com from 7 am to 7 pm Central Time, Monday through Friday.
hardship exemption categories include:
- Physician’s practice is located in a rural area without high-speed internet access.
- Physician’s practice is located in an area without sufficient available pharmacies for e-prescribing.
- Physician is registered to participate in the Medicare or Medicaid electronic health record (EHR) Incentive Program and adopted certified EHR technology by October 1, 2011, and did so prior to requesting an exemption.
- Physician is unable to electronically prescribe due to local, state or federal law or regulations.
- Physician infrequently prescribes (e.g., prescribe fewer than 10 prescriptions between January 1 and June 30, 2011).
- There are insufficient opportunities to report the e-prescribing measure due to program limitations.
- Physicians can apply for more than one exemption category if applicable to their particular situation
Exemption requests from individual physicians will not be accepted via mail, email or fax. Group practices already participating in the 2011 e-prescribing group practice reporting option must submit an exemption request via mailed letter (group exemptions cannot be submitted online or via email).
For more information, please read SFMS’ blog post here.