Avoid the 2013 e-Prescribing Penalty

The June 30th deadline is looming. If you don’t e-prescribe on 10 eligible encounters by this date, you will be subject to a 1.5% reduction on your 2013 Medicare Fee Schedule.

 First step, determine if you are an eligible professional (EP) by clicking here.

 Will the penalty apply to my EP? The 2013 penalty will not apply if:

  • The EP is not an MD, DO, podiatrist, Nurse Practitioner, or Physician Assistant by June 30, 2012 based on primary taxonomy code in the National Plan and Provider Enumeration System (NPPES)
  • The EP does not have at least 100 Medicare Part B PFS cases (that is, claims for patient services) containing an encounter code in the measure’s denominator for dates of service from  1/1/12-6/30/12*
  • The EP does not have 10 percent or more of their Medicare Part B PFS allowable charges (per TIN) for encounter codes in the measure’s denominator for dates of service from 1/1/12-6/30/12*
  • The EP does not have prescribing privileges and reported G8644 on a billable Medicare Part B service at least once on a claim between 1/1/12-6/30/12

Denominator Codes:

90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012,

92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213,

99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324,

99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344,

99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109

If any of the above scenarios applies to your EP, they will not be subject to the 2013 penalty and do not need to apply for a hardship exemption.  The centers for Medicare and Medicaid Services (CMS) will make these calculations and no action is required by the provider.

 There are 3 ways eligible professionals (EP’s) can avoid the 2013 penalty:

  • The EP was a successful electronic prescriber during the 2011 e-prescribing 12-month reporting period (reported at least 25 unique denominator eligible e-prescribing events between 1/1/11- 12/31/11), OR
  • The EP reports G8553 via claims based reporting for at least 10 Medicare Part B PFS encounters between Jan. 1- June 30, 2012. In these cases the e-prescribing G-code can be reported on any Medicare Part B claim that includes a billable Part B service, regardless of whether the claim contains coding in the measure’s denominator to avoid the penalty (data must be processed into the National Claims History (NCH) no later than July 27, 2012), OR
  • The EP applies for a Hardship Exemption by June 30, 2012 and the hardship exemption is approved by CMS (see below)

 Hardship exemption categories:

1) Unable to prescribe due to local, state or federal law or regulation

Example: EPs who prescribe a large volume of narcotics, which may not be electronically prescribed in some states, or EPs who practice in a state that prohibits or limits the transmission of electronic prescriptions via a third party network such as Surescripts.

2) Prescribe fewer than 100 times during a respective six-month reporting period Example: A nurse practitioner who may not write prescriptions under his or her own NPI, a physician who decides to let his Drug Enforcement Administration registration expire during the reporting period without renewing it.

3) Providers practicing in a rural area with limited high-speed Internet access

To request consideration for this hardship exemption: report G8642 at least once on claims, or use the web portal, by June 30, 2012.

4) Providers practicing in an area with limited available pharmacies for electronic prescribing To request consideration for this hardship exemption: report G8643 at least once on claims, or use the web portal, by June 30, 2012.

Apply for a Hardship Exemption by clicking here and following the prompts. 

The Centers for Medicare and Medicaid Services has many resources on this topic.  For more information please click here.