CMS Releases Final Rule Amending Electronic Prescribing Incentive Program

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The Centers for Medicare & Medicaid Services released a final rule on Aug. 31 amending the Medicare electronic prescribing incentive program to encourage more doctors and other health care professionals to successfully adopt and use e-prescribing technology.

Specifically, the changes will better recognize those circumstances when physicians and other clinicians are not able to meet the e-prescribing program's requirements, and when the requirements clearly pose a significant hardship for providers, Patrick Conway, chief medical officer and director of the CMS Office of Clinical Standards & Quality, said in a release.

The final rule is scheduled to appear in the Sept. 6 Federal Register. The rule will be effective 30 days after publication.

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) established the Medicare e-prescribing incentive program, which allowed eligible providers, starting in 2009, to earn incentives based on electronic prescribing activities. Medicare providers, however, face penalties beginning in 2012 if they do not meet electronic prescribing thresholds. Currently, the e-prescribing program requires physicians to electronically send at least 10 prescriptions in the first six months of 2011 to avoid penalties in 2012, and send 25 prescriptions electronically in 2012 to avoid penalties in 2013.

CMS published a proposed rule outlining the changes to the e-prescribing incentive program in the June 1 Federal Register (76 Fed. Reg. 31547) (22 MCR 662, 6/3/11).

Alignment and Flexibility

The final eRx rule also modifies the 2011 electronic prescribing measure to align with the Medicare and Medicaid electronic health record incentive programs, CMS said.

Under the final rule, a certified EHR technology system used by physicians and other clinicians to meet “meaningful use” incentive program requirements also will qualify for use in the Medicare e-prescribing incentive program. The meaningful use program requires that certified EHRs have electronic prescribing capabilities.

Additionally, CMS included four significant hardship exemptions, in addition to those already included in the e-prescribing incentive program, that will allow professionals to be exempt from the 2012 payment adjustment. The exemptions would apply to:

• eligible professionals who register to participate in the Medicare or Medicaid EHR incentive programs and adopt certified EHR technology;

• eligible professionals who are unable to electronically prescribe due to local, state, or federal laws or regulations;

• eligible professionals who have limited prescribing activity; and

• eligible professionals who do not prescribe often enough to patients to meet the e-prescribing measure requirements.

Currently, eligible professionals or group practices with limited high speed internet access and eligible professional or group practice practices in areas with limited available pharmacies for electronic prescribing are exempt from the e-precribing incentive program penalties. Deadline to Request Exemption Extended

Under the existing e-prescribing program, eligible providers who were not successful electronic prescribers based on claims submitted between Jan. 1 and June 30 of this year would have been subject to a payment adjustment for their Medicare Part B covered services in 2012.

However, the final rule extends the deadline for requesting significant hardship exemptions to Nov. 1, CMS said.

Physicians can apply for exemption via a web-based tool for individual eligible professionals and via a mailed letter for group practices that are participating in the 2011 eRx group practice reporting option, CMS said.

By Genevieve Douglas

The final rule is available at .