In the Sept. 6 Federal Register, the Centers for Medicare and Medicaid Services (CSM) published a final rule describing changes to the eRx Incentive Program. The American Medical Association (AMA) has outlined some of the major points of the final rule and necessary next steps in an eRx Incentive Program memo sent on Aug. 31.

Beginning in 2012, providers who do not successfully prescribe electronically per CMS requirements will receive a penalty, also known as a payment adjustment, of -1 percent of allowable charges.  This adjustment is projected to increase to -1.5 percent in 2013 and -2 percent in 2014.

Providers who believe they cannot meet the requirements of the eRx incentive program due to hardship can apply for exemption from the eRx program.  Major changes to the eRx program, as outlined in the final rule, include the addition of new hardship exemption categories as well as an extension of the deadline to submit a hardship exemption request.  The exemption deadline is now Nov. 1, 2011.

Based on feedback that the AASM has received, many members plan to apply for a hardship exemption in one or more of the six categories that are described in the final rule:

  • The physician’s practice is located in a rural area without high-speed internet access.
  • The physician’s practice is located in an area without sufficient available pharmacies for e-prescribing
  • The physician is registered to participate in the Medicare or Medicaid EHR Incentive Program and has adopted Certified EHR Technology (by Oct. 1, 2011).
  • The physician is unable to electronically prescribe due to local, state or federal law or regulation.
  • The physician has limited prescribing activity.
  • The physician has insufficient opportunities to report the e-prescribing measure due to limitations of the measure’s denominator.

The final rule also outlines the Web-based system that will be used for submission of exemption requests. The AASM will continue to monitor the CMS website and will notify the membership once the system is available.

Coding Corner articles are archived on the Coding Page of the AASM website for future reference.