The Center for Medicare & Medicaid Services (CMS) has proposed changes to the e-prescribing penalty program by adding more exemptions so that fewer physicians are penalized unfairly. It is unclear to what extent these new exemptions will provide relief for East Bay physicians, however.

Currently, physicians with at least 100 Medicare Part B claims with an eligible encounter code must submit at least 10 claims with code G8553 (indicating an electronic prescription was generated) in combination with an eligible encounter code by June 30, 2011, or face a claims payment reduction of 1 percent in 2012.  The ACCMA has prepared detailed guidance on the requirements and potential penalties, which can be accessed online or by calling the ACCMA at (510) 654-5383 for a copy.

The most significant change under the new proposed rule appears to be an exemption from the penalty for physicians who are registered to participate in the Medicare or Medicaid electronic health record incentive (EHR) program and have adopted certified EHR technology before October 1, 2011.  Physicians in this category are already e-prescribing by virtue of using a certified EMR system and meeting “meaningful use” criteria.  This change will allow physicians in this category to avoid the penalty without having to report eRx activity to Medicare via claims.

In addition, three new exemptions have been proposed, but few details are known about how CMS plans to objectively define these exemptions:
  • Physician is unable to electronically prescribe due to local, state or federal law or regulation (e.g., prescribes controlled substances)
  • Physician infrequently prescribes (e.g., prescribe fewer than 10 prescriptions between January 1, 2011, and June 30, 2011)
  • There are insufficient opportunities to report the e-prescribing measure due to program limitations
The ACCMA will continue to monitor developments and inform members as more information becomes available. It is expected that impacted physicians will have to apply for one of these exemptions via an online web-portal (if available in time) or by mail no later than October 1, 2011, but few specifics are currently available.