September 19, 2011

Just two weeks ago, we published an Alert headed “Anesthesiologists Will Soon Be Able to Request Their Exemptions.”  “Soon” is now.  CMS has just announced a new provider website, the Quality Reporting Communication Support Page, to enter requests for hardship exemptions from the electronic prescribing (eRx) requirement along with supporting rationales.

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. 

Before looking at the new website, recall that “eligible providers” will be subject to a penalty amounting to one percent of their Medicare allowed charges, beginning on January 1, 2012, if they did not report e-prescribing on at least ten outpatient visits during the first half of 2011 – and do not receive a hardship exemption.  The penalty will increase to 1.5 percent in 2012 and to 2.0 percent in 2014, for eligible providers who, in the preceding year, submit fewer than 25 claims for visits in which an eRx was generated, without a hardship exemption.

Most anesthesiologists (and CRNAs with prescribing privileges) will not qualify for either the eRx bonus or the eRx penalty because they submit very few electronic prescriptions and report very few of the outpatient visits encompassed by the eRx measure.  Unless an eligible provider satisfies two minimum-activity conditions, he or she will not come within the eRx requirement at all:

1. At least 100 outpatient visits for dates of service between January 1, 2011 and June 30, 2011 identified by one of the CPT™ codes in the measure specification (including codes 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214 and 99215); and
2. At least ten percent of the eligible provider’s Medicare allowed payments come from evaluation and management codes in the measure specification.

It is unlikely that physicians whose clinical activities consist principally of giving surgical anesthesia will meet either of the two conditions above.  Chronic pain specialists, on the other hand, may report 100 or more office/outpatients visits during the first six months of 2011.  Even if they do, they would typically expect to earn more than 90 percent of their Medicare allowables from procedures.  A physician in a chronic pain practice who does have that high a volume of visits will need to be a successful electronic prescriber, however – unless his or her application for a hardship exemption is granted.

It comes as a relief that the online application form is short and simple, considering all the megabytes of information on the eRx incentive program and penalty with which CMS has inundated us.  (The final eRx regulation issued on August 31, 2011 may have been daunting, but the latest summary, a Quick Reference Guide dated September 6th, consists of just two plain-English pages).   CMS’ decision to allow proxies such as billing agents or practice managers to complete the form is also welcome.  ABC will work with our clients to determine whether an exemption is needed based on their billed visits and to complete the application if appropriate.

Hardship Exemption Request

To request a hardship exemption on the Communication Support Page, the individual must provide the following information:

• User information
• Legal Business Name as enrolled in PECOS
• TIN
• NPI
• Email address
• Contact information – Requestor

• Name, address, Phone
• Relationship to User
• Billing Manager
• Healthcare Provider
• Office Manager
• Receptionist, or
• Other Office Staff
• Type of exemption requested

• Participating in 2011 Medicare or Medicaid Electronic Health Record (EHR) Incentive Program (registration ID # and EHR certification # required)
• Inability to electronically prescribe due to local, State, or Federal law or regulation
• E.g., DEA restriction on eRx for narcotics
• Limited prescribing activity
• The eligible professional wrote fewer than 10 prescriptions, electronically or on paper, during the relevant time period
• Insufficient opportunities to report the electronic prescribing measure
• The eligible professional e-prescribed, but during the course of evaluation and management services not represented by CPT™ codes in the measure denominator, e.g., during hospital inpatient visits
• Practice is in a rural area without sufficient high speed internet access
• Practice is in an area without sufficient available pharmacies for electronic prescribing
• Justification for the hardship exemption – in fewer than 250 words/1,000 characters.
• User agreement and electronic attestation

Not only is the form short; it is also multi-purpose.  You may use it to request NPI-level feedback for any of the years 2007-2011 for the Physician Quality Reporting System (PQRS), or for the applicable years for eRx participation or “Payment Adjustment” (penalty computation).

Note that the deadline for applying is November 1, 2011.

2012 eRx Payment Adjustment – User Guide

CMS has just published another User Guide that you should download:  a 17-page explanation of eRx Payment Adjustment Feedback Report that you will be able to obtain after completing the form on the Communication Support Page discussed above or otherwise on the Quality Net web portal or through your carrier/MAC.

Individual eligible professionals will receive the following information for each NPI in Table 1 of the feedback report:

• Reporting Denominator - Applicable cases that could be reported: the number of events for which the provider was eligible to report the measure, if an eRx encounter occurred. Individuals are automatically excluded from the 2012 eRx payment adjustment if the reporting denominator number is less than 100.
• Reporting Numerator - Valid Unique eRx G-codes Reported: the number of reporting events where the eRx codes submitted met the measure-specific reporting criteria. At least 10 non-hardship eRx G-codes (G8553) reported during the reporting period are required to avoid the payment adjustment.
• Actual Threshold Percent: each NPI’s percent of allowed charges during the 6-month reporting period that contained codes in the denominator of the 2011 eRx measure. The 2012 eRx payment adjustment will not apply if the NPI has fewer than ten percent. This percentage is based on Medicare allowed charges (money), not the number of cases reported.
• Subject to the 2012 eRx Payment Adjustment - whether or not the eRx payment adjustment will be applied to individual’s 2012 Medicare fee schedule payments.

These data elements will become perfectly clear if you examine the table on page 8 of the User Guide.  We do not include a copy of the table here because it is too large.  We hope that the information we have provided will be useful to you and that none of you will be subject to a payment adjustment in 2012 or later years.

With best wishes,

Tony Mira
President and CEO