CMS Issues Final Rule on eRx Incentive Program

The Centers for Medicare and Medicaid Services (CMS) issued the final ruling on the eRx Incentive Program on Wednesday, Aug. 31, 2011, which establishes both the requirements for successful reporting and the program requirements for avoiding 2012 to 2014 payment reductions.

Eligibility and Exemptions
The eligible professionals, defined as M.D.s, D.O.s and podiatrists, nurse practitioners or physician assistants, who may not be subject to a 2012 payment adjustment if they do not, or cannot, report through the CMS eRx program include those who:

• Are not considered eligible professionals as of June 30, 2011. A person who is ineligible does not generally have prescribing privileges and reports g-code G8644.
• Have fewer than 100 cases that contain an encounter code in the electronic prescribing measure’s denominator.
• Have allowed charges of 10 percent or greater of the individual’s total 2011 Medicare part B for covered professional services submitted for the eRx prescribing measure’s denominator codes that are 10 percent or greater of the individual’s total 2011 Medicare part B PFS allowed charges.
• Cannot report a significant hardship code based on the current ones, but applies for one and CMS grants an exemption. Or, the professional “becomes a successful electronic prescriber for…the 2012 payment adjustment by reporting…at least 10 unique electronic prescribing events for patients in the denominator of the measure between Jan. 1, 2011, and June 30, 2011.

The final rule as it relates to the 2011 eRx group practice reporting options states that individual practices can avoid the payment adjustment for 2012 under the following circumstances:

• A group “ reports a significant hardship in its 2011 self-nomination letter for participation in the eRx Incentive Program group practice reporting option and is granted the exemption. Or, the practice is a successful electronic prescriber by reporting electronic claims for 75 to 2,500 unique electronic prescribing event, which depends on the group practice size, between Jan. 1, 2011, and June 30, 2011.
• The group, based on a case-by-case decision, is granted an exemption for a significant hardship that is subject to an annual renewal. CMS established two significant hardship exemptions in the form of two g-codes, which must be reported at least one time on a claim between Jan. 1, 2011, and June 30, 2011:
• Code G8642: practices in a rural area without a sufficiently high-speed Internet connection.
• Code G8643: practices without sufficient available pharmacies for eRx prescribing.

However, any group practice that participates in the eRx group practice reporting option for 2011 and asks for a hardship exemption must have requested it “at the time the practice self-nominated to participate.”

CMS Changes to Hardship Exemptions and Reporting
Based on comments following the publication of the 2011 Medicare Physician Fee
Schedule (MPFS) Final Rule that covered hardship exemptions and the qualifications of current prescribing systems, CMS instituted the following changes:

• The agency modified the existing 2011 electronic prescribing measure  “to address uncertainties related to the technological requirements of the Medicare eRx Incentive Program.” The measure was “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.”
• CMS is also providing additional significant hardship exemption categories to avoid the 2012 payment adjustment, which involve eligible professionals who register to participate in the Medicare or Medicaid EHR Incentive Programs and have adopted certified EHR technology, but are: unable to electronically prescribe due to local, state or federal laws or regulations, or have limited prescribing activity or insufficient opportunities to report the electronic prescribing measure.

CMS also extended the deadline for requesting a significant hardship exemption to Nov. 1, 2011, for the two significant hardship exemptions established in the 2011 MPFS Final Rule, along with the additional exemptions noted above.

Administrators can access the final ruling at http://www.ofr.gov/OFRUpload/OFRData/2011-22629_PI.pdf.

Eligible professionals and group practices that quality for the eRx Incentive Program but fail to successfully comply with the requirements will face a 2012 adjustment of 1 percent of MPFS payments, 1.5 percent reduction in 2013 and a 2 percent reduction in 2014.