Exemption from 2012 ePrescribing Penalties

If You Qualify, It’s Now Time to Submit Your Request

New Rule: CMS has released the Final Rule that gives providers (particularly some surgeons and pain-management physicians) expanded opportunities to request an exemption from the 2012 ePrescribing penalties. The rule finalizes the Proposed Rule that amended the MIPPA 2011 ePrescribing regulations.

The deadline for providers to submit a request to CMS is November 1, 2011.

The Exemptions

The rule allows providers who are otherwise eligible for the ePrescribing program to request a “hardship exemption” from the 2012 penalties if any of the following situations—among others—prevented them from submitting the required 10 Medicare ePrescriptions by June 30, 2011:

• Inability to ePrescribe due to local, state, or federal regulations (i.e., the majority of their prescriptions are for controlled substances)

• Insufficient opportunity to ePrescribe because the bulk of prescribing activity occurs during visits other than the specified CPT codes (e.g., post-surgery visits)

• Insufficient prescribing activity (typically applies to physician assistants or nurse practitioners who don’t prescribe under their own NPI)

How to Submit a Request for Exemption

Requests will be reviewed on a case-by-case basis. To submit a request for exemption, providers must:

1) Access the exemption request form at www.qualitynet.org/pqrs. In the “Related Links” box on the upper left, click on “Communication Support Page,” which will display the online form.

2) Provide identifying information (TIN, NPI, name, mailing address, e-mail address).

3) Identify the hardship category under which you are requesting an exemption. If more than one applies, include the second in the justification statement.

4) Submit a justification statement explaining how ePrescribing represents a significant hardship (the statement needs to be compelling, because there is no appeal process—the decision of CMS is final).

5) Attest to the accuracy of the above information.

Although requests will be accepted through November 1, providers should file as early as possible to avoid any potential reprocessing of claims. (If the exemption is approved too late in the year, 2012 claims will be initially paid at the reduced rate and then reprocessed, creating an unnecessary administrative headache for your billing department.)

Providers should continue ePrescribing, regardless of their potential exemption from 2012 penalties. They can still earn a 1% ePrescribing bonus for 2011 by ePrescribing on a total of 25 Medicare encounters during the entire calendar year.

Related posts:

  1. Two Critical Steps to Avoid ePrescribing Penalties
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