This post was written by APMA’s Director of Scientific Affairs James R. Christina, DPM.

James R. Christina, DPM, Director of Scientific Affairs

Just when you thought you had figured out the CMS electronic prescribing (eRx) program to avoid the payment reduction in 2012, the agency releases a proposed rule with additional penalty exemptions. But let’s go back to the beginning of this story. Over the past several years, CMS has implemented incentive payment programs to promote the use of quality measures, like the Physician Quality Reporting System (PQRS), and to encourage electronic prescribing.  Although these programs are voluntary, those who participate are able to receive additional monetary incentives. In 2009, CMS reported that successful participants in the PQRI (now PQRS) program received about $2,000 per eligible provider, and successful participants in the eRx program received about $3,000 per eligible provider.  So those who did not participate potentially missed out on an additional $5,000 in payments from CMS.  APMA has provided webinars and resources on how to participate in these programs and receive the incentive payments.

For 2011, CMS is again offering incentive payments for participating in eRx (1 percent of your total part B billings for the year) and for participating in the PQRS (also a 1 percent bonus).  Again, participation to obtain these incentive payments is voluntary, but now there is a twist. In 2012, based on your use of electronic prescribing in 2011, you may be subject to a 1 percent payment reduction for all of your 2012 CMS billings.

Originally, the program required participants to write 10 unique e-prescriptions using a qualified e-prescribing system between January 1 and June 30, 2011.  Due to the way the measure is written, this essentially meant that only e-prescriptions done in conjunction with an office visit (evaluation and management codes) counted toward the 10 unique prescriptions. The measure included a few exceptions, including hardship for lack of Internet access in rural areas, lack of pharmacies in rural areas that accepted e-prescriptions, having less than 100 visits in the denominator of the measure (essentially evaluation and management visit codes) or if those codes in the denominator represented less than 10 percent of your total Part B billings for the six-month period.

Now CMS is adding four other potential exemptions, if the proposed rule is adopted:

• Purchasing and registering a certified electronic health record (EHR) system with the intent to report meaningful use of the EHR
• Inability to electronically prescribe due to local, state, or federal law or regulation;
• Limited prescribing activity (eligible professional who prescribed fewer than 10 prescriptions between January 1 and June 30, 2011, regardless of whether the prescriptions were electronically prescribed or not)
• Insufficient opportunities to report the electronic prescribing measure due to limitations of the measure’s denominator (eligible professional does write prescriptions but they are not associated with office visit codes, e.g. surgeon)

APMA’s advice is to still try to meet the original requirements of 10 e-prescriptions before June 30, 2011, in order to avoid the uncertainty of being exempt under the new proposed rule. More information about e-prescribing, including a webinar on the CMS eRx deadline, can be found on the APMA website.