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Are You Exempt from the 2012 eRx Penalties?

By Karen Zupko

Did you (physician, physician assistant, or nurse practitioner) successfully e-Prescribe and report G8553 on 10 Medicare billable E&M office visits by June 30, 2011? If not, read below to see if you qualify for the “significant hardship exemptions” recently finalized by CMS. If you can answer “yes” to any of the following, apply for the hardship exemption by November 1st (details below)

  • Do you have and use an EHR and have registered to participate in the Medicare or Medicaid EHR Incentive Program for 2011?
  • Did you have an e-Prescribing system in place by June 30, 2011 and found that you were unable to electronically prescribe due to local, State or Federal law or regulation (i.e. large volume of narcotics)?
  • Did you have limited prescription activity, meaning you prescribed less than 10 Medicare prescriptions from Jan 1 – Jun 30? (total prescriptions, regardless of whether they could be electronically prescribed or not) Or are you a non-physician provider (NPP) who does not write prescriptions under your own NPI?
  • Did you have an e-Prescribing system in place by June 30, 2011 and found that there were insufficient opportunities to report the e-Prescribing measure due to limitations of the measure’s denominator (i.e. you primarily prescribed medications during non-billable pre-op or post-op visits).
  • Do you practice in a rural area without high speed internet access?
  • Do you practice in an area without sufficient available pharmacies for electronic prescribing?

If you answered “yes” to any of the above, you are eligible to apply for the “significant hardship exemptions”.

  • Physicians MUST make this request themselves (not your staff). CMS has announced that billing managers, office managers, receptionists, and other office staff cannot submit an eRx hardship exemption request on behalf of their eligible professionals. Click here for the CMS reference.
  • CMS will review requests for exemptions on a case-by-case basis. You have 250 words or less to justify your exemption request – take this seriously as there is no appeal process if CMS denies your request. Keep in mind if your request is approved, you will have to reapply annually to keep the exemption.
  • Click here to apply for the significant hardship exemption request. Deadline is November 1, 2011.

If you answered “no” to all of the above and

Your Medicare E&M Visits > 10% of total Medicare dollars

Your Medicare E&M Visits > 100 for Jan 1 – Jun 30, 2011

You had prescribing privileges as of Jun 30, 2011

You will be subject to the 1% Medicare payment reduction for 2012. However, there is still the opportunity to e-Prescribe NOW and earn the e-Prescribing incentive of 1% for 2011. e-Prescribe and report G8553 (indicating you e-Prescribed during the visit) at least 25 times for Medicare billable office visits (non-billable pre-op and post-op visits don’t count) between now and December 31, 2011. Not only will you earn the incentive for 2011, but you will avoid the penalty for 2013. (Note, you cannot earn the e-Prescribing bonus and receive the EHR Meaningful Use incentive in the same year).

Don’t have an eRx system? Visit www.nationalerx.com to learn about a FREE internet based system.

Want more information?

Click here to read the Federal Register.
Click here to visit CMS’s website.

Need personalized assistance as it relates to e-Prescribing, Meaningful Use, or PQRS? KZA Consultants are available under hourly contract to assist your practice in implementing these Medicare programs. Contact your KZA Consultant or Cheyenne Brinson at cbrinson@karenzupko.com for more information.

Karen Zupko & Associates specializes in advising surgeons about the business side of their practice. They provide coding education and auditing for practices across the country, from solo surgeons to academic departments and publicly traded entities. Call Colleen Gallagher, (312) 642-5616, to discuss the scope and cost of services.


Written by

Mr. Watts joined DDI after several years as a national medical malpractice insurance broker with Arthur J. Gallagher. Mr. Watts concentrated on business development in Illinois and Texas but had clients in nine states. Prior to Gallagher, Mr. Watts was the Sales Manager for CARE Risk Retention Group, a medical malpractice insurance company that sold insurance in 15 states.

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