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The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the 2011 Medicare Electronic Prescribing (eRx) Incentive Program Final Rule was published in Federal Register on September 6, 2011.

To help eligible professionals and group practices understand the key provisions and impact of the 2011 Medicare Electronic Prescribing (eRx) Incentive Program Final Rule, A Quick Reference Guide has been posted to the eRx Incentive Program website on the “Educational Resources” page. Frequently asked questions (FAQs) addressing the 2011 eRx Final Rule, as well as other information and resources about the eRx Incentive Program can be found at the eRx Incentive Program Web site.

What are the key changes addressed in the final rule?

  • The final rule modifies the electronic prescribing (eRx) quality measure used for certain reporting periods in calendar year (CY) 2011.
  • The final rule provides additional significant hardship exemption categories for eligible professionals and group practices to request an exemption during 2011 for the 2012 eRx payment adjustment due to a significant hardship: (1) eligible professionals who register to participate in the Medicare or Medicaid EHR Incentive Program and adopt certified EHR technology; (2) eligible professionals who are unable to electronically prescribe due to local, state, or federal law or regulation; (3) eligible professionals who have limited prescribing activity; and (4) eligible professionals who have insufficient opportunities to report the e-prescribing measure due to limitations of the measure’s denominator.
    The two hardship exemptions already available to professionals are (1) eligible professional or group practice practices in rural areas with limited high speed internet access; and (2) eligible professional or group practice practices in an area with limited available pharmacies for electronic prescribing.
  • The final rule extends the deadline for requesting significant hardship exemptions to November 1, 2011. The final rule allows providers to report significant hardship exemptions to the 2012 eRx payment adjustment via a Web-based tool for eligible professionals or via a mailed letter for group practices that are participating in the eRx group practice reporting option for 2011.

What immediate impact does this have on me?

At this time, eligible professionals and group practices should determine if they are subject to the 2012 eRx payment adjustment.

An eligible professional will not be subject to the 2012 eRx payment adjustment if ONE of the following applies:

  • The eligible professional is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of June 30, 2011 (This determination is based on the primary taxonomy code in the National Plan and Provider Enumeration System (NPPES)) and does not generally have prescribing privileges, and reports g-code G8644 (defined as not having prescribing privileges) at least one time on an eligible claim prior to June 30, 2011;
  • The eligible professional does not have at least 100 cases (i.e., claims for patient services ) containing an encounter code that falls within the denominator of the eRx measure for dates of service between January 1, 2011 and June 30, 2011;
  • The eligible professional’s allowed charges for covered professional services submitted for the electronic prescribing measure’s denominator codes is less than 10 percent of the eligible professional’s total 2011 Medicare Part B PFS allowed charges;
  • The eligible professional reported one of the two significant hardship code already finalized (see Bullet 2 under Key Changes above) by June 30, 2011 and CMS determines that the hardship code applies and is granted an exemption; OR
  • The eligible professional becomes a successful electronic prescriber for purposes of the 2012 payment adjustment by reporting the electronic prescribing measure via claims for at least 10 unique electronic prescribing events for patients in the denominator of the measure between January 1, 2011 and June 30, 2011.

A group practice that self-nominated and was selected to participate in the 2011 eRx group practice reporting option (GPRO) will not be subject to the 2012 eRx payment adjustment if ONE of the following applies:

  • The group practice reported one of the two significant hardship code already finalized (see Bullet 2 under Key Changes above) in its 2011 self-nomination letter for participation in the eRx Incentive Program group practice reporting option and is granted an exemption; OR
  • The group practice becomes a successful electronic prescriber. The group practice becomes a successful electronic prescriber for purposes of the 2012 payment adjustment by reporting the electronic prescribing measure via claims for between 75-2,500 unique electronic prescribing events (depending on the group practice size) for patients in the denominator of the measure between January 1, 2011 and June 30, 2011.

What should I do if I believe I am subject to the 2012 eRx payment adjustment?

If you believe you are subject to the 2012 eRx payment adjustment, you should determine if you meet any of the hardship exemptions that CMS has finalized. If you do feel you meet one of the hardship exemptions, you have until November 1, 2011 to submit your hardship exemption request and rationale.

How do I submit a 2012 eRx Payment Adjustment Significant Hardship Exemption Request?

CMS is no longer accepting significant hardship exemption requests for the 2012 eRx payment adjustment via claims. However, we are accepting hardship exemption requests through other avenues. Below are the steps you need to take to request a significant hardship exemption. Please note that the action required is different depending on whether you are an individual eligible professional or a group practice.

  • If you are participating as an individual Eligible Professional: Use the new CMS provider webpage, called the Quality Reporting Communication Support Page, to enter the request and supporting rationale. Your request must be submitted by November 1, 2011. A Quality Communications Support Page User Manual is available to answer questions eligible professionals may have.
  • If you are participating using the Group Practice Reporting Option (GPRO): Group practices selected for and participating in the 2011 GPRO I or II reporting option wishing to submit a 2012 exemption request should submit a letter to: Significant Hardship Exemptions, Centers for Medicare & Medicaid Services, Office of Clinical Standards and Quality, Quality Measurement and Health Assessment Group, 7500 Security Boulevard, Mail Stop S3-02-01, Baltimore, MD 21244-1850. This letter must be postmarked no later than November 1, 2011.

Geanelle G. Herring MSW
Centers for Medicare & Medicaid Services
Provider Communications Group
Division of Provider Relations & Outreach


Page updated: 09/27/11

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Contact Information

R. Dobbin Chow, MD, FACP,
Governor, Maryland Chapter

Maryellen Woodward
920 Trinity Street
Baltimore, MD 21202
Chapter Administrator
Office: 410-332-8444
Fax: 410-636-3403
E-mail: mew4work@aol.com