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Proposed Changes to CMS eRx Program (announced May 2011)

At the end of May 2011, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would update the Electronic Prescribing (eRx) Incentive Program. The changes would expand the number of providers able to qualify for a hardship exemption to the program and allow them to avoid a penalty (payment adjustment) scheduled to take place in 2012. More specifically, under current regulations, eligible professionals (EP) will be penalized 1 % of total allowed Medicare charges submitted throughout 2012 if they do not report a minimum of 10 eRx reporting events during the 6 month period of January 1, 2011 to June 30, 2011. Reporting must be made through claims. A related requirement has been specified for group practices participating in the program.

The changes recently released by CMS are in proposed form. Thus, the specific additional hardship exemptions and their requirements will not be known until the final rule is released, and the exemptions may differ from the proposed form. Thus, the College strongly recommends that physicians who are able to comply with the current eRx requirements should still attempt to do so.

The new proposed hardship exemptions are:

  • EP who register to participate in the EHR Incentive Programs by October 1, 2011 and adopt certified EHR technology.
  • EP who are unable to electronically prescribe due to local, state, or federal law or regulation (e.g. prescriptions for controlled substances).
  • EP who engage in limited prescribing activity, while still having prescribing privileges.
  • EP who have insufficient opportunities to report the electronic prescribing measure due to limitations of the measure’s denominator e.g. physicians, such as many surgeons, who do not normally write prescriptions associated with the type of visits included in the eRx measure

CMS is proposing to allow EP to submit hardship requests once the proposed rule is finalized, which is expected to be by no later than October 1, 2011. If the proposed rule does not become effective before that date, then CMS proposes that the EP must submit the hardship request by no later than 5 business days after the effective date of the rule. EP will also have until October to apply for the two hardship exemptions that are in the current eRx regulations

CMS is also proposing to develop a web based tool through which to request these hardship exemptions and will also allow EP to submit exemption requests through the mail. All hardship exemption requests will be reviewed and considered by CMS on a case-by-case basis.

The public comment period for this proposed rule ends on July 25, 2011. The full proposed rule is available at http://www.gpo.gov/fdsys/pkg/FR-2011-06-01/pdf/2011-13463.pdf[PDF]. The College will provide updates regarding these proposed changes as they develop.

Additional information about the current eRx Incentive Program and what you need to do to be compliant is available here.

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