Quality Reporting Communication Support Page Now Available for Medicare eRx Payment Adjustment Hardship Exemption Requests
Published on: April 17, 2012
In 2009, the Centers for Medicare & Medicaid Services (CMS) implemented the Electronic Prescribing (eRx) Incentive Program, which is a program that uses incentive payments and payment adjustments to encourage the use of qualified electronic prescribing systems.
From calendar year (CY) 2012 through 2014, a payment adjustment that increases each calendar year will be applied to an eligible professional's Medicare Part B Physician Fee Schedule (PFS) covered professional services for not becoming a successful electronic prescriber. The payment adjustment of 1.0 percent in 2012, 1.5 percent in 2013, and 2.0 percent in 2014 will result in an eligible professional or group practice participating in the eRx Group Practice Reporting Option (eRx GPRO) receiving 99.0 percent, 98.5 percent, and 98.0 percent respectively of their Medicare Part B PFS amount for covered professional services.
Avoiding the 2013 eRx Payment Adjustment
Individual eligible professionals and CMS-selected group practices participating in eRx GPRO who were not successful electronic prescribers in 2011 can avoid the 2013 eRx payment adjustment by meeting the specified reporting requirements between January 1 and June 30, 2012.
Six-month Reporting Requirements to Avoid the 2013 Payment Adjustment:
- Individual Eligible Professionals – 10 eRx events via claims
- Small eRx GPRO – 625 eRx events via claims
- Large eRx GPRO – 2,500 eRx events via claims
For more information on individual and eRx GPRO reporting requirements, please see the MLN Article SE1206 - 2012 Electronic Prescribing (eRx) Incentive Program: Future Payment Adjustments.
CMS may exempt individual eligible professionals and group practices participating in eRx GPRO from the 2013 eRx payment adjustment if it is determined that compliance with the requirements for becoming a successful electronic prescriber would result in a significant hardship.
The significant hardship categories are as follows:
- The eligible professional is unable to electronically prescribe due to local, state, or federal law, or regulation.
- The eligible professional has or will prescribe fewer than 100 prescriptions during a six-month reporting period (January 1 – June 30, 2012).
- The eligible professional practices in a rural area without sufficient high-speed Internet access (G8642).
- The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing (G8643).
Submitting a Significant Hardship Code or Request
To request a significant hardship, individual eligible professionals and group practices participating in eRx GPRO must submit their significant hardship exemption requests through the Quality Reporting Communication Support Page (Communication Support Page) on or between March 1 and June 30, 2012. CMS will review these requests on a case-by-case basis. All decisions on significant hardship exemption requests will be final.
Significant hardships associated with a G-code may be submitted via the Communication Support Page or on at least one claim during the 2013 eRx payment adjustment reporting period (January 1 – June 30, 2012). If submitting a significant hardship G-code via claims, it is not necessary to request the same hardship through the Communication Support Page.
For more information on how to navigate the Communication Support Page, please reference the following documents on the CMS website:
Additional information and resources are available on the CMS website.
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