The deadline for Medicare e-Prescription (eRx) is June 30th, 2012. As a Medicare provider, you may be subject to 1.5% Medicare penalty if you do not send 10 electronic prescriptions and report 10 corresponding G-codes. Physicians who are subject to a penalty are also required to adjust co-insurance or co-pay amounts. Medicare E-Prescription Payment Adjustment Medicare e-Rx Incentive Program is designed to encourage adoption of e-prescribing. In order to keep keep track of the eRx reporting, all Medicare providers (subject to exceptions below) are required to report Medicare’s assigned G-Code — G8553. Since G8553 is only for reporting purposes, providers are advised to report the code with a $0 charge amount. However, please note that some systems do not accept a charge with $0 value. In this case, a charge amount of $0.01 could be used instead. In response to your claim, Medicare will indicate a specific code–N365–on the remittance advice. The N365 code is your indication that the G8553 code passed into the Medicare National Claims History (NCH) database. Note: Although you cannot receive both the Electronic Health Record (EHR) incentive and the eRx incentive in the same year, you must report at least 10 eRx  to avoid the eRx penalty. How to avoid the penalties? 

  • Activate your e-prescribing;
  • Send at least 10 electronic e-prescriptions from your EHR; and
  • File your Medicare claims with the G-code G8553 for the 10 eRx encounters before June 30th, 2012.

Are there any exclusions? You will be automatically be excluded from the requirement if one of the following applies:

  • You are not an MD, DO, Podiatrist, Nurse Practitioner, or Physician Assistant as of June 30, 2012;
  • You have successfully met the 25 G-code e-prescribing requirement in 2011;
  • Less than 100 of your claims for Medicare Part B patient services contain visit and service codes that fall within the e-prescribing measure specifications (see boxed note below) for dates of service between January 1, 2012 and June 30, 2012; and
  • Office visits and other services listed in the CMS e-prescribing measure specifications (see boxed note below) represent less than 10% of your allowed Medicare Part B charges for dates of service between January 1, 2012 and June 30, 2012.

[box type=”note” style=”rounded” border=”full”]To successfully meet the eRx reporting requirements, the following service codes should be reported with G8533: 90801, 90802, 90804, 90805, 90806, 90807, 0808, 90809, 90862, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109[/box] If you meet one of the above criteria, you will automatically be excluded from the penalty and no action is required on your part. You could also be excluded if one of the following scenarios apply to you:

  • You do not have prescribing privileges. You must report the code, G8644, on a billable Medicare Part B service at least once on a claim from January 1 through June 30, 2012;
  • You practice in a rural area without sufficient high-speed internet access (report the code, G8642 at least on one claim to Medicare);
  • Your practice is in an area without sufficient available pharmacies for electronic prescribing (report code, G8643 at least on one claim to Medicare);
  • You are unable to electronically prescribe due to local, State or Federal law or regulation, (e.g., physicians who mainly prescribe narcotics but because of state law cannot submit these prescriptions electronically can apply for this exemption category);
  • You prescribe fewer than 100 prescriptions between January 1, 2012 and June 30, 2012.

You could request for an exclusion at Individual physicians must apply on-line via CMS’ Web-based tool for an exemption by no later than June 30, 2012, in order to avoid the January 1, 2013, Medicare e-prescribing penalty. Applications cannot be submitted via mail, e-mail, or fax. We also recommend reporting 25 G-codes this year, since you will otherwise have to meet the same 10 G-code requirement in 2013 to avoid a 2% deduction in 2014. [twitter style=”horizontal” float=”left”]

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