American Society of Hematology

CMS Issues Update on eRx Payment Adjustment

Published on: March 27, 2012

The Centers for Medicare & Medicaid Services (CMS) has announced that it continues to receive inquiries regarding the Medicare Electronic Prescribing (eRx) Incentive Program and the 2012 eRx payment adjustment. In response, CMS has provided the following information to clarify some of the issues brought up by the physician and other health-care professional community.

Statutory Authority/Background
CMS is required to subject eligible professionals who are not successful electronic prescribers to a payment adjustment beginning in 2012. This requirement is outlined in Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (P.L.110-275) (MIPPA).

CMS has 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 on September 6, 2011, to provide additional circumstances for eligible professionals to apply for a hardship exemption. Eligible professionals initially had until November 1, 2011, to submit a request for a hardship exemption via the newly-created Quality Reporting Communication Support Page for the 2012 eRx payment adjustment; however this deadline was later extended to November 8, 2011. CMS finished their review of these requests in February 2012 and continue 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 their QualityNet Help Desk. The QualityNet Help Desk can be reached at 866-288-8912 or via email at

2013 & 2014 eRx Payment Adjustment
Payment adjustments under the eRx Incentive Program run until 2014. More information is available on the CMS website.

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