Payment Adjustments to Physician Claims Begin in Electronic Prescribing Incentive Program

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CMS has begun applying a one-percent downward payment adjustment to claims submitted by eligible professionals (EPs) who have not met the Electronic Prescribing (eRx) Incentive Program quality measure during the January 1, 2011 through June 30, 2011 reporting period or applied for and received a hardship exemption. To meet the eRx quality measure, EP claims for services rendered during the reporting period must have contained a code indicating that the EP was a successful e-prescriber. To qualify for a hardship exemption, EPs had to provide CMS with a request by November 1, 2011.

In September 2011, CMS added a hardship exemption for EPs who have registered for the Medicare or Medicaid EHR Incentive Programs. However, an EP must have requested this hardship exemption by the November 1, 2011 deadline to avoid application of the payment adjustment. Claims for services rendered during the reporting period were due no later than July 31, 2011, and claims may not be resubmitted to include the appropriate codes.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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