Payment Adjustment Information

Electronic Prescribing (eRx) Payment Adjustment Information

Beginning 2012, Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (P.L.110-275) (MIPPA) requires CMS to subject eligible professionals who are not successful electronic prescribers under the eRx Incentive Program to a payment adjustment. This payment adjustment applies to all of the eligible professional's Part B-covered professional services under the Medicare Physician Fee Schedule (MPFS). From 2012 through 2014, the payment adjustment will increase with each new reporting period. Accordingly, for 2012, eligible professionals receiving a payment adjustment will be paid 1.0% less than the MPFS amount for that service. In 2013 and 2014, the payment adjustment increases to 1.5% and 2.0% respectively.

Significant Hardship Exception: Eligible professionals may be exempt from the application of the payment adjustment if CMS determines that compliance with the requirement for being a successful electronic prescriber would result in a significant hardship. This hardship exception is subject to annual renewal.

For all inquiries regarding the eRx Incentive Program payment adjustment, including if an eligible professional believes a payment adjustment was erroneously applied, please contact the Help Desk Support. Contact information for the Help Desk Support is available by clicking the "Help Desk Support" link at left.

2014 eRx Payment Adjustment

2014 eRx Payment Adjustment Feedback Report User Guide

A quick reference guide for understanding the 2014 eRx Payment Adjustment Feedback Report has been posted in the "Downloads" section below.  The 2014 eRx Payment Adjustment Feedback Report User Guide is designed to assist eligible professionals, group practices participating in eRx Group Practice Reporting Option (GPRO), and their authorized users in accessing and interpreting the 2014 eRx Payment Adjustment Feedback Report.

2013 eRx Payment Adjustment

2013 eRx Incentive Program: 2014 Payment Adjustment. 

This article provides guidance on avoiding the 2014 eRx payment adjustment.  To view click on the document titled "2013 eRx Incentive Program: 2014 Payment Adjustment" in the "Downloads" section below.

2013 eRx Payment Adjustment Informal Review Made Simple

This Fact Sheet provides step-by-step guidance for those eligible professionals and eRx GPROs receiving the 2013 eRx payment adjustment who wish to request an informal review of the 2013 eRx payment adjustment determination.  To view click on the link titled "2013 eRx Payment Adjustment Informal Review Made Simple" in the "Downloads" section below. 

eRx Incentive Program: Updates for 2013

This Fact Sheet contains information about changes to the 2013 eRx Incentive Program incentive payment and the 2014 eRx payment adjustment as authorized by MIPPA. To view click on the link titled "eRx Incentive Program: Updates for 2013" in the "Downloads" section below. 

Updated! 2013 Electronic Prescribing (eRx) Payment Adjustment Quick Reference Guide

A quick reference guide for understanding the 2013 eRx Payment Adjustment has been posted in the "Downloads" section below.  This document describes how the 2013 eRx payment adjustment was 1) assessed and 2) applied for individual eligible professionals and self-nominated and CMS-selected group practices participating in the eRx Group Practice Reporting Option (GPRO).

Important Update on 2013 Electronic Prescribing Payment Adjustment Hardship Exemptions

On November 1, CMS finalized two new electronic prescribing (eRx) significant hardship exemption categories pertaining to the EHR Medicare and Medicaid Incentive Program in the 2013 Medicare Physician Fee Schedule Rule.  

Specifically, these hardship exemptions categories are:
 Eligible professionals who achieve meaningful use during certain eRx timeframes. For the 2013 eRx payment adjustment, this will include any eligible professional who achieved meaningful use during January 1, 2011 through June 30, 2012 and has attested to this by January 31, 2013.
 Eligible professionals who demonstrate intent to participate in the EHR Incentive Program and adoption of Certified EHR Technology by registering for the EHR Incentive Program by January 31, 2013.  Please note: EHR Incentive Program participants must provide their entire EHR Certification Number  in the CMS EHR Certification ID field during registration to receive this hardship.

Eligible professionals do not need to apply for these 2 EHR-related hardship exemptions through the Quality Reporting Communication Support web page (Communication Support Page). They only need to register or attest for the EHR Incentive Program by January 31, 2013.  However, if an eligible professional previously registered for the EHR Incentive Program but did not supply the EHR certification Number for their EHR product at that time, and has not since achieved meaningful use, they need to go back and add that piece of information to their registration before January 31, 2013.

Register and attest for the EHR Incentive Program. For questions relating to participation in the Medicare and Medicaid EHR Incentive Program, please contact EHR Incentive Program Information Center at 888-734-6433 (TTY 888-734-6563.)

As a reminder, CMS re-opened the Communication Support Page to allow individual eligible professionals and CMS-selected group practices the opportunity to request a significant hardship exemption for the 2013 eRx payment adjustment. Significant hardship requests should be submitted via the Communication Support Page on or between November 1, 2012 and January 31, 2013. Please remember that CMS will review these requests on a case-by-case basis.  All decisions on significant hardship exemption requests will be final. The following eRx hardship exemption categories are available for request on the Communication Support Page:
 Inability to electronically prescribe due to state, or federal law, or local law or regulation;
 The eligible professional prescribes fewer than 100 prescriptions during a 6–month payment adjustment reporting period;
 The eligible professional practices in a rural area without sufficient high-speed Internet access (G8642); and
 The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing (G8643).

For more information on how to navigate the Communication Support Page, please reference the following documents:
 PQRS & eRx Quality Reporting Communication Support Page User Manual
 Tips for Using the Quality Reporting Communication Support Page

To be assured that we receive your hardship exemption request, it must be summated through the Communication Support Page by 11:59pm ET on January 31, 2013.

Important—please note that this is for the 2013 eRx payment adjustment only. Hardship exemption requests for the 2014 payment adjustment will be accepted during a separate timeframe later in calendar year 2013.  

Eligible professionals who experience difficulties accessing the Communication Support Page or have questions about the eRx Incentive Program should contact the QualityNet Help Desk at 866-288-8912 or qnetsupport@sdps.org. The help desk is available Monday through Friday from 7am through 7pm CT.

Eligible professionals are encouraged to review MLN Matters® Article #SE1206, “2012 Electronic Prescribing (eRx) Incentive Program: Future Payment Adjustments” for more information, including who may be subject to the eRx payment adjustment and how to avoid the eRx payment adjustment.  

To be assured that we receive your hardship exemption request, use the link provided below by 11:59 PM EST on January 31, 2013.

https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234

We would like to advise eligible professionals who experience difficulties accessing the Communication Support Page outside of the maintenance hours stated above to please contact the QualityNet Help Desk.

QualityNet Help Desk – Monday– Friday, 7:00 AM – 7:00 PM CST
• General CMS Physician Quality Reporting System and eRx Incentive Program information
• Portal password issues
• Feedback report availability and access
• PQRI-IACS registration questions
• PQRI-IACS login issues
Phone: 1-866-288-8912
TTY: 1-877-715-6222
Email: Qnetsupport@sdps.org

MLN Matters Article SE1206 - 2012 Electronic Prescribing (eRx) Incentive Program: Future Payment Adjustments.

This article provides guidance on avoiding future Electronic Prescribing (eRx) Incentive Program payment adjustments for individual eligible professionals and selected group practices participating in the 2012 eRx Group Practice Reporting Option (GPRO).  The article is available under the "Related Links Inside CMS" section below.  

Communication Support Page User Manual

The Communication Support Page is available through QualityNet (www.qualitynet.org). A User Manual has been developed to provide step by step instructions on how to navigate through the Communication Support Page. To view this guide click on the link titled "Communication Support Page User Manual" in the "Related Links Outside CMS" section below.

2012 eRx Payment Adjustment

Quick-Reference Guide for Understanding the 2012 eRx Payment Adjustment

A document titled "Quick-Reference Guide for Understanding the 2012 eRx Payment Adjustment" has been posted below in the "Downloads" section.  This document describes how the 2012 eRx payment adjustment was 1) assessed and 2) applied for individual eligible professionals and self-nominated and CMS-selected group practices participating in the eRx Group Practice Reporting Option (GPRO).