CMS (Medicare) e-Prescribing Incentives and Penalties: June 20th Update!

For eligible professionals who are not already successful e-prescribers, the June 30 deadline to avoid 2012 Medicare payment adjustments is fast approaching. Naturally, there is heightened interest from providers about eligibility requirements and how to avoid the 1% payment adjustment (i.e., penalty) on 2012 Medicare Part B allowables.

For those eligible professionals who have waited until now or are unable to meet the requirement to report 10 unique e-prescribing events by June 30, the bad news is that there are precious few days to avoid the 2012 payment adjustment.

The good news…there’s one more chance for all eligible professionals to get onboard. Even if you miss the June 30 deadline, you can still offset the 2012 adjustment by qualifying for a 1% incentive based on 2011 Medicare allowables. And all an eligible professional needs to do to qualify for the 1% incentive is report 25 unique e-prescribing events by December 31, 2011.

Also, by meeting the year-end deadline, you avoid the 2013 payment adjustment, which is worse than the 2012 adjustment.

So the message is loud and clear: “Even if you can’t meet the June 30 deadline, make sure you don’t miss meeting the December 31 deadline!”

For detailed information about the rules of the Medicare E-Rx Incentive Program, please visit the CMS E-Prescribing Program Website
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Frequently asked questions from customers:

What is the Medicare e-Prescribing Incentive Program and who is it for?
Starting on January 1, 2009, CMS began offering incentives for eligible professionals under the Medicare program using a qualified e-Prescribing system. The program uses a carrot and stick approach, starting with incentives for “successful e-prescribers” (2% in 2009-2010, 1% in 2011-2012, and 0.5% for 2013) and phasing in payment adjustments, or penalties, for those not successfully e-prescribing (1% in 2012, 1.5% in 2013, and finally 2% in 2014 and each year thereafter.)

What is an “eligible professional” under this program?
CMS defines an eligible professional as one who provides a minimum number or “covered professional services” which are “paid under the Medicare Physician Fee Schedule (PFS).” An eligible professional is typically a medical doctor, though other practitioners and medical professionals may be eligible. An eligible professional must also have valid prescribing authority in the state in which they practice. For more details on program eligibility: https://www.cms.gov/ERxIncentive/05_Eligible%20Professionals.asp#TopOfPage

What does an eligible professional need to do to meet the program requirements?
An eligible professional must report a minimum number of unique e-prescribing events within a reporting year using a “qualified e-prescribing system.” In 2011, the goal is 25 unique events by the end of the year to capture the incentive. However, the deadline to avoid penalties in 2012 is June 30, 2011.

More information about this process is at https://cms.gov/ERxIncentive on the “How to Get Started” page.