Medicare Electronic Prescribing (eRx) Payment Adjustment

Beginning in 2012, the Centers for Medicare and Medicaid Services (CMS) will require a payment adjustment for eligible professionals (EPs) who are not electronic prescribers under the Electronic Prescribing (eRx) Incentive Program. To learn more about what constitutes an eligible professional, visit the CMS website.

This payment adjustment applies to all Part B-covered professional services under the Medicare Physician Fee Schedule (MPFS). From 2012 through 2014, the payment adjustment will increase with each new reporting period. Accordingly, for 2012, EPs receiving a payment adjustment will be paid 1.0 percent less than the MPFS amount for that service. In 2013 and 2014, the payment adjustment increases to 1.5 percent and 2.0 percent respectively.

Eligible professionals may be exempt from the payment adjustment if CMS determines that compliance with the requirement would result in a significant hardship. An EP may meet the hardship exemption from the 2012 eRx payment adjustment if one of the following circumstances applies:

• Individual practices in rural areas without high speed internet access
• Individual practices in areas without sufficient available pharmacies for electronic prescribing
• Practitioners who have registered to participate in the Medicare or Medicaid EHR Incentive Program and have adopted certified EHR technology
• Practitioners who are unable to electronically prescribe due to local, state, or federal law or regulation (This proposed exemption is designed to address practitioners who prescribe controlled substances)
• Practitioners who infrequently prescribe (For 2012, this means a practitioner must not have had the opportunity to e-prescribe at least 10 times between January and the end of June 2011 in order to qualify for the exemption)
• Practitioners with insufficient opportunities to report the e-prescribing measure due to program limitations

Eligible professionals and group practices have until November 1, 2011, to submit a significant hardship exemption request and rationale (learn more). CMS created a web portal to allow EPs to submit the exemption requests and supporting documentation: access the submission portal now »

Group practices participating under the group practice reporting option (GPRO) must submit hardship exemption requests via a letter to:

Significant Hardship Exemptions, Centers for Medicare & Medicaid Services
Office of Clinical Standards and Quality, Quality Measurement and Health Assessment Group
7500 Security Boulevard
Mail Stop S3-02-01
Baltimore, MD 21244-1850

For more information about the eRx Incentive Program, visit the CMS website.