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Electronic Prescribing: A Medicare Cut is Looming for all Physicians in 2012 and 2013

Posted In Health Care Law

Technology is wonderful! It seems like everyday our lives become easier and more convenient due to the ever changing world of IT. We can do almost anything over the Internet…order tickets, shop, chat, and now…even obtain prescription medications.

Although this is suppose to increase efficiency of healthcare by providing patients and clinicians with quick and easy submission of prescriptions, many physicians have difficulty in mastering the skills necessary to integrate electronic prescribing into their practices. When technology becomes a legal requirement, there are financial consequences to physicians who do not comply.

Since 2009, the Centers for Medicare and Medicaid Services has offered an incentive for eligible professionals (“EP”) to implement and use electronic prescribing (“eRx”) in order to improve the quality, efficiency and safety of healthcare delivered to beneficiaries. Electronic prescribing, also known as e-prescribing or "e-Rx," is a prescriber's ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care. This initiative has continued during 2011 with successful e-prescribers earning a bonus of 1% of their total allowed charges for professional services covered by the Medicare Part B Physician Fee Schedule.

Now, for the first time, the 2011 eRx program includes a payment-adjustment or penalty component. EPs that do not implement and use an eRx system in 2011 will be penalized in 2012 and 2013 by a cut in Medicare payments! The first penalty will be assessed as a 1% cut in the 2012 allowable Physician Fee Schedule billings if you did not comply by June 30, 2011 The next deadline is December 31, 2011 to avoid a 1.5% penalty for 2013 billings!

CMS has allowed for exemptions to this rule. CMS finalized the changes to the E-Prescribing Incentive Program rule with four new exemption categories for the 2012 eRx penalty if the physician was non-compliant with the 10 eRx requirement. In determining if the physician was non-compliant, CMS will review eRx activity from the first half of 2011 to determine if the physician processed 10 electronic prescriptions during that time frame. If they did not meet the 10 eRx minimum by June 30, 2011, providers will be given until November 1, 2011 to claim one of the following exemptions:

• He/She is an eligible professional who registered to participate in the Medicare or Medicaid EHR Incentive Program and adopted       certified EHR technology**

• He/She was unable to electronically prescribe due to local, state, or federal law or regulation

• He/She had limited prescribing activity

• He/She had insufficient opportunities to report the e-prescribing measure due to limitations of the measure’s denominator

Physicians who have not yet, or are unable to, comply with the E-Prescribing Incentive Program will be penalized with a 1.5% penalty for 2013 billings unless they apply and quality for an exemption. November 1, 2011 is only days away!

Posted by: Gina M. Riddell

Gina M. Riddell is a Paralegal of McBrayer, McGinnis, Leslie & Kirkland, PLLC. Ms. Riddell concentrates her practice in healthcare law and is located in the firm’s Lexington office. She can be reached at griddell@mmlk.com  or at (859) 231-8780.

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