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 email@example.com.
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.
Below is a list of updates to clarify common issues CMS has heard from physicians and other healthcare professionals regarding the Medicare Electronic Prescribing (eRx) Incentive Program and the 2012 eRx payment adjustment.
CMS is required to adjust the payments of eligible professionals who are not successful electronic prescribers beginning in 2012. This requirement is outlined in Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
CMS listed the requirements for being a successful e-prescriber for purposes of avoiding the 2012 payment adjustment in the 2011 Physician Fee Schedule final rule. In February 2012, all eligible professionals who did not meet these requirements were sent a letter notifying them of this fact.
Significant Hardship Exemption Requests
In response to stakeholder feedback, CMS also published a standalone eRx rule in September 2011 to provide additional circumstances under which eligible professionals would qualify for hardship exemptions. Eligible professionals initially had until November 1, 2011, to submit a request for a hardship exemption for the 2012 eRx payment adjustment via the newly-created Quality Reporting Communication Support Page; this deadline was later extended to November 8, 2011. CMS finished its review of these requests in February 2012 and continues to notify requestors via email whether their request was approved or denied.
Questions and Concerns
Although there is no appeal or review process established for the eRx Incentive Program and payment adjustment, CMS encourages eligible professionals with questions or concerns about the eRx payment adjustment and hardship exemption requests to contact the QualityNet Help Desk. Through the QualityNet Help Desk, CMS is working with eligible professionals and CMS-selected group practices that have questions about eRx payment adjustments and/or hardship exemption decisions. CMS is handling all hardship exemption requests and any questions or concerns on a case-by-case basis. Contact the QualityNet Help Desk if you have issues relating to the eRx payment adjustment and/or the rationale for denial of your hardship exemption request.
The QualityNet Help Desk can be reached Mon – Fri, 7 am to 7 pm CMT, at (866) 288-8912 or QNetSupport@sdps.org.
2013 & 2014 eRx Payment Adjustment
Please note that payment adjustments under the eRx Incentive Program run until 2014. For information on how to avoid the 2013 and 2014 eRx payment adjustments, please visit the Electronic Prescribing Incentive Program webpage and review MLN Matters Article #SE1206.
In its annual March report to Congress (PDF), the Medicare Payment Advisory Commission (MedPac) reiterated its position that federal lawmakers should repeal Medicare’s sustainable growth-rate (SGR) formula and replace it with 10 years of statutory fee-schedule updates.
That course of action would include a freeze in current payment levels for primary care, and, for all other services, reductions of 5.9% for three years, followed by a freeze. The March report contained the letter from MedPAC to federal lawmakers last October that included a host of ways to pay for repealing the SGR, such as applying an excise tax to Medigap plans, rebasing payments to skilled-nursing facilities and applying a readmission policy to skilled-nursing facilities, home health agencies, long-term, acute-care hospitals, and inpatient rehabilitation services.
Totaling more than 400 pages, the report presents to Congress suggestions on Medicare payment policy that MedPAC’s commissioners agreed to in January, such as a 1% payment increase in payment rates to the inpatient and outpatient prospective payments systems for 2013. Other recommendations for 2013 include a payment update of 0.5% for the ambulatory surgery center and hospice segments, and no payment increases for skilled-nursing facilities, long-term-care hospitals and inpatient rehabilitation facilities.
The report also said Congress should direct the HHS secretary to begin a two-year rebasing of home health rates in 2013, and also establish a per-episode co-payment for home health episodes that are not preceded by hospitalization or post-acute-care use. MedPAC made both of those recommendations for the first time a year ago.
The Centers for Medicare & Medicaid Services (CMS) announced yesterday that they would again extend the enforcement discretionary period, allowing practices an additional 90 days to become fully compliant with the use of HIPAA 5010 transaction standards. What this means for physicians is that while the implementation date of January 1, 2012, is still in effect, contractors will not reject claims submitted in the 4010 electronic formats until July 1, 2012.
CMA has also surveyed the major payors in California to understand whether they will require claims to be submitted in 5010 format on April 1. While some did require 5010 on January 1, others were allowing for contingencies until April 1. SFMS members will receive a quick reference guide with information on which major payors will require 5010 transactions on April 1 in the March SFMS eNewsletter (due out today).
SFMS/CMA encourages all physicians to continue working with their vendors, clearing houses and billing services to transition to the 5010 format as soon as possible. Offices that transmit directly must ensure their software is updated.
Internet-based PECOS (Provider Enrollment, Chain, and Ownership System) now allows providers and suppliers to sign Medicare enrollment applications electronically. Providers can save time and expedite review of your application by using internet-based PECOS. (This feature does not change who is required to sign the application.)
In internet-based PECOS, all Individual Provider applications that do not include new reassignments may e-sign the application as part of the submission process. This applies to Physicians and Non-Physician Practitioners, including those enrolling just to order and refer.
Any Organizational Provider applications that are submitted via internet-based PECOS will require the user completing the application to provide an email address for the authorized official/delegated official (AO/DO) of the application as part of the submission process. The AO/DO can then follow the instructions in the email and electronically sign the application. This applies to Institutional Providers; Clinics, Group Practices, and Certain Other Suppliers; and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers.
Any Individual Provider application (855-I) containing new reassignments (855-R) can be electronically signed as part of the submission process; however, you must select the AO/DO for the Organization that is accepting the reassignment and enter that official’s email address. The official then will be required to follow the instruction in the email and electronically sign the application.
If an individual provider or AO/DO does not want to make use of the e-signature process, they can simply follow the current process of printing and signing the certification statement (which then needs to be mailed to their appropriate contractor).
Learn more about PECOS at https://PECOS.CMS.hhs.gov, and be on the look-out for more enhancements in the coming months! Questions concerning a system issue regarding PECOS should be referred to the CMS EUS Help Desk at (866) 484-8049 or EUSSupport@cgi.com.