EHR and practice management for mental / behavioral health

ePrescribing Penalties

by Leigh-Ann Renz, 6.6.13

Could you be subject to ePrescribing penalties?!

According to the Department of Health & Human Services: “Physicians and other practitioners who qualify as eligible professionals to participate in the Centers for Medicare & Medicaid Services (CMS) Electronic Prescribing (eRx) Incentive Program are affected [by the 2012 Electronic Prescribing (eRx) Payment Adjustment].”

Not sure if you qualify as an eligible professional?  Click here for details.

Additionally: “Under Section 1848(a)(5)(A) of the Social Security Act, eligible professionals who are not successful electronic prescribers under the eRx Incentive Program will be subject to a payment adjustment in 2012. An eligible professional was included in the 2012 eRx payment adjustment analysis if they meet all of the following criteria:

  • Was a physician (MD, DO, or podiatrist), Nurse Practitioner, or Physician Assistant as of June 30, 2011, based on primary taxonomy code in the National Plan and Provider Enumeration System (NPPES);
  • Had prescribing privileges from 1/1/11-6/30/11;
  • Had at least 100 cases containing an encounter code in the measure’s denominator from 1/1/11-6/30/11; AND
  • Had 10% or more of their Medicare Part B allowable charges (per Tax Identification Number (TIN) from 1/1/11-6/30/11 were for encounter codes in the measure’s denominator

Eligible professionals were automatically excluded from the 2012 eRx payment adjustment analysis if they did NOT meet one of the above criteria”

And what are the adjustments? 

“Eligible professionals who met the eRx payment adjustment inclusion criteria, but who failed to meet the reporting requirements in 2011, may receive the 2012 eRx payment adjustment starting January 1, 2012. The 2012 eRx payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice participating in eRx GPRO receiving 99% (1% less) of their Medicare Part B Physician Fee Schedule (PFS) amount that would otherwise apply to such services.”

Any way around this?! 

YES: The recently released 2013 Medicare Final Rule has provided 2 ways to avoid future payment adjustments (penalties) under the MIPAA ePrescribing rule (if you have not already taken necessary actions to avoid them):

1) The exemption request period has been reopened for providers who missed the June 30 deadline.  From now until January 31, 2013, providers can access the Quality Reporting Communication Support Page and create a hardship exemption request based on one of the following reasons:

  • “Inability to electronically prescribe due to local, State, or Federal law or regulation (i.e., prescribe predominantly controlled substances)
  • Prescribed fewer than 100 prescriptions between January 1 and June 30, 2012
  • Insufficient high speed internet access (i.e., rural area)
  • Insufficient available pharmacies that accept electronic prescribing”

2) Meaningful use will satisfy the eRx requirements.  “CMS now will provide two additional ways to avoid the 2013 MIPPA penalties:

  • Achieve meaningful use during 2013
  • Demonstrate intent to participate in the EHR Incentive Program and adopt Certified EHR Technology by January 31, 2013

This information will be retrieved by CMS from the information in its EHR Incentive Program’s Registration and Attestation System, rather than by having providers request an exemption as in 1) above.”

Sources/Additional Information:
EMR & HIPAA blog
CMS EHR Incentive Programs
CMS 2012 Electronic Prescribing (eRx) Payment Adjustment
Contact the QualityNet Help Desk M-F, 7 am – 7 pm CMT at 866.288.8912 or via email at
Contact Medicare directly at

The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

leigh-Ann Renz is the Marketing & Business Development Director of PIMSY EHR. For more information about electronic solutions for your practice, check out Mental Health EMR.



Leigh-Ann Renz is the Marketing & Business Development Director of PIMSY EHR. For more information about electronic solutions for your practice, check out Mental Health EMR.




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