CMS releases e-prescribing incentive program final rule

The Centers for Medicare & Medicaid Services (CMS) announced changes to the Medicare e-prescribing (eRx) incentive program for 2011.

Since publication of the 2011 Medicare Physician Fee Schedule (MPFS) final rule, CMS has received public comments raising concern that the Medicare eRx incentive program did not align with the Medicare or Medicaid EHR incentive program, as well as the need for additional significant hardship exemption categories. 

To address these concerns, CMS announced the following changes:

• Modify the existing 2011 e-prescribing measure to address uncertainties related to the technological requirements of the Medicare eRx incentive program: The existing 2011 e-prescribing measure is revised to indicate that a qualified electronic prescribing system includes certified EHR technology.

• Provide additional significant hardship exemption categories for purposes of the 2012 payment adjustment: The eligible professional or group practice must demonstrate that one of these situations applies:

1. Eligible professionals who register to participate in the Medicare or Medicaid EHR incentive programs and adopt certified EHR technology;
2. Inability to e-prescribe due to local, state, or federal law or regulation;
3. Limited prescribing activity; or
4. Insufficient opportunities to report the e-prescribing measure.

• Extend the deadline for requesting significant hardship exemptions to Nov. 1. This extended reporting deadline would apply to the two significant hardship exemptions established in the 2011 MPFS final rule as well as the additional significant hardship exemption categories.
• Require significant hardship exemption submission requests for the 2012 eRx payment adjustment via web-based tool for individual eligible professionals and a mailed letter for group practices participating in the 2011 eRx group practice reporting option. 

Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) required the Secretary of Health and Human Services to establish a new reporting program for eligible professionals who are successful electronic prescribers as defined by MIPPA, beginning on Jan. 1, 2009. While the eRx incentive program has similarities in structure and processes to the Physician Quality Reporting System (formerly the Physician Quality Reporting Initiative), this program is separate with distinct program reporting requirements and associated incentive payments and payment adjustments.

In addition to the e-prescribing incentive payment, MIPPA called for MPFS payment adjustments that will apply beginning in January 2012 to eligible professionals who are not successful electronic prescribers, as defined in the 2011 MPFS final rule.

For eligible professionals who are subject to the 2012 eRx payment adjustment, the fee schedule for covered professional services furnished by eligible professionals during the year shall be 1 percent less than the fee schedule amount that would otherwise apply for 2012. The potential MPFS reductions in the future are a 1.5 percent reduction for 2013 and 2.0 percent reduction for 2014.

The final rule can be found here.