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Doctors get another chance to avoid Medicare e-prescribing penalty

CMS will let physicians claim a hardship exemption that would prevent a downward payment adjustment from taking effect in 2013.

By Charles Fiegl — Posted Nov. 5, 2012

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Doctors who were unable to meet Medicare electronic prescribing requirements will have a second chance to claim a hardship exemption and prevent the 2013 e-prescribing penalty from reducing their Medicare pay.

The Centers for Medicare & Medicaid Services will allow physicians and other eligible health professionals an additional window of time in which to file hardship exemptions, indicating to the agency that a 1.5% penalty should not be applied to all Medicare rates next year, officials said. Any physician who did not request an exemption by the original due date, June 30, now can file a hardship application by Jan. 31, 2013.

The American Medical Association had pushed for additional chances for physicians to avoid the penalty adjustment when circumstances out of their control prevented them from e-prescribing.

“The AMA has consistently advocated for more flexibility under the Medicare e-prescribing exemption categories, and we are pleased that CMS is allowing physicians who missed the June deadline to file for a hardship between Nov. 1 and Jan. 31 to avoid a 2013 penalty,” said AMA President Jeremy A. Lazarus, MD. “We urge CMS to continue to make improvements to the program so that physicians are not unfairly penalized.”

CMS is required by law to reduce Medicare rates for eligible professionals who do not meet e-prescribing reporting requirements. About 135,000 doctors and other health professionals have seen their Medicare pay reduced by 1% in 2012 because they did not report at least 10 electronic orders for medications within a six-month reporting period in 2011. Physicians reporting at least 25 e-prescribing encounters earned a bonus equal to 1% of their Medicare charges in 2011. Doctors can earn the same incentive for reporting 2012 e-prescribing, but those earning a bonus from the program’s electronic health record program are not eligible for the e-prescribing bonus.

There has been a lack of alignment between the Medicare incentive and penalty programs, which has caused problems for physicians. Successful participation in the EHR program, which includes an electronic prescribing component, does not automatically exempt a physician from the e-prescribing penalty.

In mid-October, CMS officials sent email notices announcing the re-opening of the 2013 hardship exemption application Web portal starting on Nov. 1. A physician claiming an exemption enters his or her identifier information and selects the appropriate hardship. The exemption categories are available only to physicians and health professionals who:

  • Could not e-prescribe due to state, federal or local law or regulation.
  • Lacked sufficient e-prescribing opportunities, such as by ordering fewer than 100 prescriptions during the six-month reporting period.
  • Practiced in a rural area without sufficient high-speed Internet access.
  • Practiced in an area without sufficient numbers of pharmacies that can accept paperless medication orders.

The proposed 2013 Medicare physician fee schedule, published in July, would create two additional e-prescribing exemption categories for doctors who earn, or who plan to earn, EHR bonuses. Those additional exemptions would not be available to doctors until after CMS confirms them in the final fee schedule, which had not been published by this article’s deadline.

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External links

E-prescribing exemption reporting website, Centers for Medicare & Medicaid Services (link)

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