ERx - The Carrot and the Stick

March 2nd, 2012

A few of our clients received letters yesterday from CMS saying their reimbursement would be decreased by 1% because they had not complied with Medicare ERx guidelines.  The letters also said that Medicare had not yet processed the requests for hardship exemptions that were due at the end of October, 2011.

Fortunately, Medicare has modified its rules for 2012 making it a little easier for providers to comply with ERx requirements and avoid 2013's 1.5% decrease for noncompliance.

Now, a provider can submit an ERx with ANY visit; not just with certain outpatient 90000 level codes.  Thus, you may wish to include G8553 with charges for hospital claims where prescribing is done electronically.  Hospital codes were not acceptable in 2012 for ERx compliance purposes.

Note, however, that using this option only avoids penalties; it does not satisfy requirements for ERx incentives.  In order to receive the individual provider 2012 incentive payments, providers still must report ERxs primarily with office evaluation and management services. 

To be a successful electronic prescriber for the 2012 eRx Incentive Program and earn a 1.0% incentive payment for the 2012, a provider must report the eRx measure for at least 25 unique electronic prescribing events during 2012.  The measuring, however, is January 1 through June 30 so best practices would require 25 accepted claims before June 30 per practitioner.

To know if your ERx has been accepted by the National Claims History database, look for denial code N365 on your remittance advice.  (KLA tracks these for our billing clients.)  Yes, it is counter-intuitive to look for a denial code; but remember you are charging out 0 for this code.  Thus, Medicare is paying nothing on the EOB.

Medicare issued a summary of the 2012 requirements in January 2012.  The link is a good summary, but unfortunatly many of the links within the document aren't active.  The correct link to the CMS section about ERx is:

A group practice may also potentially qualify to earn an eRx incentive payment equal to 1.0% of the group practice's   total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during the 2012.  Small groups must complete 625 ERxs to qualify.  Large groups must complete 2,500.

To qualify for the group incentive you must self nominate for 2012.  Nomination forms are available on the CMS ERx Incentive pages under Group Practice Reporting.

If you need a free method for ERx, feel free to sign up for Practice Fusion through KLA's link at:  KLA will not contact you if you take advantage of our link; but feel free to call us with questions.

You will need to fax Practice Fusion some information such as your DEA and proof of identity to get set up for ERx, but it is a free service.  In fact, Practice Fusion had the more providers qualify for stimulus money in 2012 than any other EMR system.

Tags: ERx, Incentives


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