CMS releases final eRx rule
The Centers for Medicare & Medicaid Services (CMS) on Wednesday announced changes to the Medicare Electronic Prescribing (eRx) Incentive Program for calendar year 2011.
CMS received public comments raising concerns that the Medicare eRx Incentive program did not better align with the Medicare or Medicaid EHR Incentive Program also about the need for additional significant hardship exemption categories.
Among individuals and organizations submitting comments was the American Medical Association.
“While we appreciate the modifications CMS presented in the proposed rule, they don’t go far enough,” AMA immediate past president Cecil B. Wilson, MD, said in his letter to CMS last month. “More changes are needed, including establishing an additional reporting period in 2012 and not applying penalties until 2013.”
CMS is making the following changes in the final rule:
Modify the existing 2011 electronic prescribing measure to address uncertainties related to the technological requirements of the Medicare eRx Incentive Program: The existing 2011 electronic prescribing measure is revised to indicate that a qualified electronic prescribing system includes certified EHR technology as defined at 42 CFR 495.4 and 45 CFR 170.102.
Provide additional significant hardship exemption categories for purposes of the 2012 payment adjustment: The eligible professional or group practice must demonstrate that one of these situations applies to the respective practice:
- Eligible professionals who register to participate in the Medicare or Medicaid EHR Incentive Programs and adopt certified EHR technology;
- Inability to electronically prescribe due to local, state or federal law or regulation;
- Limited prescribing activity; or
- Insufficient opportunities to report the electronic prescribing measure.
Extend the deadline for requesting significant hardship exemptions to Nov. 1, 2011. This extended reporting deadline would apply to the two significant hardship exemptions established in the calendar year 2011 MPFS Final Rule as well as the additional significant hardship exemption categories above.
Require submission of significant hardship exemption requests for the 2012 eRx payment adjustment via a web-based tool for individual eligible professionals and via a mailed letter for group practices that are participating in the 2011 eRx group practice reporting option.
Provisions of the 2012 eRx Payment Adjustment
In addition to establishing the requirements for successful reporting of the electronic prescribing measure for the 2011 eRx incentive, the final rule also establishes the program requirements for purposes of avoiding the 2012 payment adjustment.
An eligible professional will not be subject to the 2012 payment adjustment if one of the following applies:
- The eligible professional is not a physician (MD, DO or podiatrist), nurse practitioner or physician assistant as of June 30, 2011 (This determination is based on the primary taxonomy code in the National Plan and Provider Enumeration System (NPPES)) and does not generally have prescribing privileges, and reports g-code G8644 (defined as not having prescribing privileges) at least one time on an eligible claim prior to June 30, 2011;
- The eligible professional does not have at least 100 cases containing an encounter code in the electronic prescribing measure’s denominator;
- The eligible professional’s allowed charges for covered professional services submitted for the electronic prescribing measure’s denominator codes is less than 10 percent of the eligible professional’s total 2011 Medicare Part B PFS allowed charges;
- The eligible professional reports a significant hardship code and CMS determines that the hardship code applies (see “Significant Hardship Exemptions” section below) and is granted an exemption; or
- The eligible professional becomes a successful electronic prescriber for purposes of the 2012 payment adjustment by reporting the electronic prescribing measure via claims for at least 10 unique electronic prescribing events for patients in the denominator of the measure between January 1, 2011 and June 30, 2011.
A group practice that is participating in the 2011 eRx group practice reporting option will not be subject to the 2012 payment adjustment if one of the following applies:
- The group practice reports a significant hardship in its 2011 self-nomination letter for participation in the eRx Incentive Program group practice reporting option (see “Significant Hardship Exemptions” section below) and is granted an exemption; or
- The group practice becomes a successful electronic prescriber. The group practice becomes a successful electronic prescriber for purposes of the 2012 payment adjustment by reporting the electronic prescribing measure via claims for between 75-2,500 unique electronic prescribing events (depending on the group practice size) for patients in the denominator of the measure between January 1, 2011 and June 30, 2011.
The rule also provides for hardship exemptions determined on a case-by-case basis.