2012 Medicare eRx Payment Adjustment Update

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.

Statutory Authority/Background

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.

November 8 New Deadline to Apply for Medicare eRx Exemption

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 qnetsupport@sdps.org 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.