2011 E-Rx Incentive Program Final Rule

The Centers for Medicare & Medicaid Services (CMS) announced a final rule on August 31, 2011, that makes changes to the Medicare Electronic Prescribing (eRx) Incentive Program for calendar year 2011. CMS made several changes including eligibility requirements and exemptions. As explained in the final rule, an eligible professional will not be subject to the 2012 payment adjustment if one of the following applies:

The Eligible professional:

• Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of June 30, 2011 and does not generally have prescribing privileges, and reports G-Code G8644 (defined as not having prescribing privileges) at least one time on an eligible claim prior to June 30, 2011
• Does not have at least 100 cases containing an encounter code in the electronic prescribing measure's denominator
• Submits allowed charges for covered professional services for the electronic prescribing measure's denominator codes at less than 10 percent of the eligible professional's total 2011 Medicare Part B PFS allowed charges
• Reports a significant hardship code and CMS determines that the hardship code applies (see "Significant Hardship Exemptions" section below) and is granted an exemption
• Becomes a successful electronic prescriber for purposes of the 2012 payment adjustment by reporting the electronic prescribing measure via claims for at least 10 unique electronic prescribing events for patients in the denominator of the measure between January 1, 2011 and June 30, 2011

CMS has also mades the following changes in the final rule:

• Modifying the existing 2011 electronic prescribing measure to address uncertainties related to the technological requirements of the Medicare eRx Incentive Program (the existing 2011 electronic prescribing measure is revised to indicate that a qualified electronic prescribing system includes certified EHR technology
• Providing additional significant hardship exemption categories for purposes of the 2012 payment adjustment: the eligible professional or group practice must demonstrate that one of these situations applies to the respective practice:
• • Eligible professionals who register to participate in the Medicare or Medicaid EHR Incentive Programs and adopt certified EHR technology
  • Inability to electronically prescribe due to local, state, or federal law or regulation
  • Limited prescribing activity
  • Insufficient opportunities to report the electronic prescribing measure.
• Extending the deadline for requesting significant hardship exemptions to November 1, 2011 (this extended reporting deadline would apply to the two significant hardship exemptions established in the CY 2011 Medicare Physician Fee Schedule Final Rule as well as the additional significant hardship exemption categories above)
• Requiring submission of significant hardship exemption requests for the 2012 eRx payment adjustment via a web-based tool for individual eligible professionals (instructions on how to request a hardship via the web-based tool will be available on the eRx Incentive Program website)