The 2% penalty is the punitive side of a federal program designed to motivate physicians and other clinicians to replace their prescription pads with iPads, smart phones, and the like. In 2010, the Centers for Medicare & Medicaid Services (CMS) began paying bonuses to clinicians who e-prescribe for their Medicare patients. The bonus that year was 2% of a clinician’s Medicare reimbursement. In 2013, the final year for these incentive payments, the bonus is 0.5%.
Last year, Medicare began penalizing clinicians who had not previously qualified as “successful electronic prescribers,” in CMS parlance, or electronically transmitted at least 10 scripts for Medicare patients in the first half of the 2011. That number of e-prescriptions, reported to CMS through G codes on Medicare claims, is not enough to earn a bonus, but it staves off the penalty, which was 1% in 2012. The penalty disappears after 2014.
Clinicians will be exempt from the 2% penalty in 2014 if they:
- qualified for an e-prescribing bonus during 2012;
- did not have at least 100 Medicare claims in the first 6 months of 2013 with 1 of the 50-plus billing codes that must be associated with an e-prescription for it to count toward the bonus;
- did not generate 10% or more of their Medicare allowable charges in the first 6 months of 2013 with the required billing codes;
- were not a physician, podiatrist, nurse practitioner, or physician assistant as of June 30;
- achieved “meaningful use” under the Medicare or Medicaid incentive programs for electronic health record (EHR) systems in either 2012 or the first 6 months of 2013, and reported that to CMS by June 30, 2013;
- registered to participate in one of the EHR incentive programs by June 30 and adopted certified EHR technology; or
- Lacked prescribing privileges and indicated that with code G8644 at least once on a Medicare claim before June 30.
Clinicians also can apply for one of several hardship exemptions, which include practicing in a rural area without sufficient high-speed Internet access and being barred by local, state, or federal law from e-prescribing. The deadline for a hardship exemption application, accomplished with a G code on a Medicare claim, is June 30.”
More information about avoiding the Medicare e-prescribing penalty is available on the CMS Web site, or feel free to give us a call-888-880-0384