Physicians! Another Chance to Avoid a 1.5% Reduction of All Medicare Payments in 2013

Avoid The Medicare Payment Cut

The Centers for Medicare and Medicaid Services (CMS) just announced that the Quality Reporting Communication Support Page (where you go to apply for one of the four hardship exemptions from the 2013 1.5% Medicare payment reduction) will re-open November 1, 2012 through January 31, 2013 for Medicare 2013 Electronic Prescribing (eRx) Payment Adjustment Hardship Exemption Requests.

Beginning November 1, 2012, CMS will re-open the Quality Reporting Communication Support Page to allow individual eligible professionals and CMS-selected group practices the opportunity to request a significant hardship exemption for the 2013 eRx payment adjustment. Significant hardship request should be submitted via the Quality Reporting Communication Support Page (Communication Support Page) on or between November 1, 2012 and January 31, 2012. CMS will review these requests on a case-by-case basis. All decisions on significant hardship exemption requests will be final.

Important — Please note that this is for the 2013 eRx payment adjustment only. Hardship exemption requests for the 2014 payment adjustment will be accepted during a separate time frame later in calendar year 2013.

Are you already exempt from the 2013 1.5% payment cut?

The 2013 eRx payment adjustment only applies to certain individual eligible professionals. CMS will automatically exclude those individual eligible professionals who meet the following criteria:

  • The eligible professional was a successful electronic prescriber during the 2011 (yes, 2011!) eRx 12- month reporting period (January 1, 2011 through December 31, 2011).
  • The eligible professional is not an MD, DO, podiatrist, Nurse Practitioner, or Physician Assistant by June 30, 2012, based on primary taxonomy code in the National Plan and Provider Enumeration System (NPPES).
  • The eligible professional does not have at least 100 Medicare Physician Fee Schedule (MPFS) cases containing an encounter code in the measure’s denominator for dates of service from January 1, 2012 through June 30, 2012.
  • The eligible professional does not have 10% or more of their MPFS allowable charges (per TIN) for encounter codes in the measure’s denominator for dates of service from January 1, 2012 through June 30, 2012.
  • The eligible professional does not have prescribing privileges and reported G8644 on a billable Medicare Part B service at least once on a claim between January 1, 2012 and June 30, 2012.

Avoiding the 2013 eRx payment adjustment through hardship exemptions

CMS may exempt individual eligible professionals and group practices participating in eRx GPRO from the 2013 eRx payment adjustment if it is determined that compliance with the requirements for becoming a successful electronic prescriber would result in a significant hardship.

Significant Hardships

The significant hardship categories are as follows:

  • The eligible professional is unable to electronically prescribe due to local, state, or federal law, or regulation
  • The eligible professional has or will prescribe fewer than 100 prescriptions during a 6-month reporting period (January 1 through June 30, 2012)
  • The eligible professional practices in a rural area without sufficient high-speed Internet access
  • The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing

Submitting a Significant Hardship Request

To request a significant hardship, individual eligible professionals and group practices participating in eRx GPRO must submit their significant hardship exemption requests through the Quality Reporting Communication Support Page (Communication Support Page) on or between November 1, 2012 and December 31, 2012.

Significant hardships associated with one of the four above reasons may be submitted ONLY via the Communication Support Page.

For more information on how to navigate the Communication Support Page, please reference the following documents:

For additional information and resources, please visit the E-Prescribing Incentive Program web page.

If you have questions regarding the eRx Incentive Program, eRx payment adjustments, or need assistance submitting a hardship exemption request, please contact the QualityNet Help Desk at 866-288-8912 (TTY 877-715-6222) or via qnetsupport@sdps.org. They are available Monday through Friday from 7am to 7pm CST.

Posted in: Electronic Medical Records, Medicare & Reimbursement, Medicare This Week

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2 Comments

  1. Deborah Keith December 20, 2012

    our office has been e-prescribing but di not know about the cpt code therefore i would like to request a hardship reduction form please thank you Deborah

  2. Mary Pat Whaley December 20, 2012

    Hi Deborah,

    Applying for the hardship is done electronically. I would click on the links I provided that tell you how to navigate around the Hardship Exemption Page, then go to the page by clicking on this link: https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234

    If you have any trouble using the Hardship Exemption Page, let me know!

    Best wishes,

    Mary Pat

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