Anesthesia Coding Alert

Check whether your group might fall into one of four new categories.

The push toward e-prescribing is in full swing, with physicians possibly being subjected to a one percent payment hit on CMS claims in 2012 if you don't successfully participate in e-prescribing this year (and larger hits in 2013 and 2014). If your physicians haven't yet met e-prescribing criteria, take hope: CMS has proposed four additional ways that eligible professionals(EPs) can potentially avoid the adjustment in 2012.

The imminent penalty for physicians who don't e-prescribe "has created quite a bit of concern about circumstances where doctors will potentially be penalized, not necessarily because of failure to electronically prescribe, but more so because of some complexities with regard to the measurement," said Michael Rapp, MD, JD, director of the quality measurement and health assessment group at CMS, during a May 26 CMS Open Door Forum.

Previously, physicians could apply for a hardship exemption only if they could prove a lack of access to the internet in their area or limited access to pharmacies that accepted electronic prescribing. Under the new proposal, EPs would be eligible to request a hardship exemption that CMS would determine on a case-by-case basis if they meet one of the following additional four criteria, Rapp said.

1. Registering With Intent to Adopt EHR Technology

Practitioners who intend to start participating in the EHR (Electronic Health Record) Incentive Program might still be getting their technology in place, so they may not have eprescribed ten times within the first six months of 2011, as is required to avoid the penalty. The new proposal aims to offer those practices a potential exemption.

2. Prescribing Meds That Legally Cannot Be Electronically Transmitted

Many state, local, or federal regulations prohibit EPs from electronically prescribing certain medications, such as narcotics. Practices that prescribe large quantities of these drugs (such as some pain management physicians) may find that they can't electronically prescribe even if they'd like to participate in the incentive program.

"Many physicians, so we're told, principally prescribe narcotics, and there is no way that they can effectively prescribe narcoticsusing electronic prescribing in their circumstances, and that would create a hardship for those doctors," Rapp said during the call.

3. Experiencing Limited Prescribing Activity

Some practitioners may appear to be eligible for the e-prescribing penalty because they perform enough office visits to meet the threshold, but might not prescribe medications for various reasons.

"If you don't prescribe, it would be unfair to require you to just do some prescribing which you wouldn't otherwise do," Rapp said. "Now we're proposing that physicians and other eligible professionals can request a hardship exemption on that basis."

4. Finding Insufficient Opportunities to Report Measure Due to Denominator Limitations

Issues persist that are inherent to the e-prescribing measure denominator under the program. "The denominator is limited to certain billing codes, so even though the person electronically prescribes, the physician does it in circumstances other than those that are billed for," Rapp said. For example, a physician might electronically prescribe, but the prescriptions aren't associated with the types of visits included in the e-prescribing measure's denominators.

Apply for Exemption by Oct. 1

Under the proposal, EPs would have until Oct. 1, 2011 to request a hardship exemption. A request should include:

• Identifying information such as the TIN, NPI, name, address, and email address of all affected EPs
• The hardship exemption categories that apply
• A justification statement describing how the e-prescribing requirement would create a significant hardship
• An attestation of the accuracy of the information.

CMS will determine exemptions on a case-by-case basis, and the exemptions only apply to penalties that would be imposed in 2012--not subsequent years, Rapp noted. You can comment on the proposal for the additional four exemptions through July 25 by visiting www.regulations.gov, clicking "submit a comment," and entering the ID "CMS-3248-P."