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Electronic E-Prescribing Must be in Place in 2011 to Avoid Penalties in 2012

As most providers are already aware, Centers for Medicare and Medicaid Services (CMS) has a fiscal year of October 1 through September 30. Therefore, the year 2012 for CMS and some regulatory purposes actually begins October 1, 2011.  The year 2012 is the beginning of a graduated disincentive for e-prescribing starting at a  0.5% decrease in Medicare reimbursement up to a 2% decrease in 2014.

The first six months of 2011 will be the determining time frame for the 2012 decrease, as recorded from a CMS update released November 18, 2010.

"For purposes of determining which eligible professionals or group practices are subject to the payment adjustment in 2012, CMS will analyze claims data from January 1, 2011 -  June 30, 2011, to determine if the eligible professional has submitted at least 10 electronic prescriptions during the first six months of calendar year 2011.  Group practices reporting as a GPRO I or GPRO II in 2011 must report all of their required electronic prescribing events in the first six months of 2011 to avoid the payment adjustment in 2012." 

Please remember there are exemption or hardship codes that should be included on a claim for eligible providers who are unable to e-prescribe.  These codes are G8642 and G8643 for rural areas and unavailable pharmacies to receive an e-prescription, respectively.  Also, there will be a G code for a provider who may not have prescription privileges.

For additional information regarding the Electronic Prescribing (eRx) Incentive Program, visit the CMS website http://www.cms.gov/erxincentive or download the Medicare's Practical Guide to the Electronic Prescribing (eRx) Incentive Program published by the Department of Health and Human Services in February 2010.

For more information, contact HORNE Manager Sharon Walden at sharon.walden@horne-llp.com or 225.755.9798.