MGMA urges CMS to extend e-prescribing program deadline

May 23, 2012

With only 1 month left to start e-prescribing or face a penalty, one management group is trying to buy you more time. How long of a reprieve do you need?

June 30 is the deadline for reporting on at least 10 electronic prescriptions to avoid the 2013 Medicare e-prescribing program penalty, but the Medical Group Management Association (MGMA) wants the Centers for Medicare and Medicaid Services (CMS) to extend reporting and hardship exemption deadlines to December 31.

“Our members face great difficulty understanding the criteria for avoiding e-prescribing penalties annually as each year the requirements, deadlines, and timeframes for reporting have changed significantly,” MGMA President and Chief Executive Officer Susan Turney wrote in a letter to Marilyn Tavenner, acting administrator of CMS.

Turney said that CMS’ system of applying penalties based on a prior year’s reporting activities further complicates the reporting and penalty process, causing confusion and unfair fines.

“CMS should use its regulatory authority to change this approach going forward, and where penalties exist, they should be based on actual performance during the time period for which they are applied,” she added.

MGMA suggests that CMS simplify its data-reporting processes by deeming all doctors who meet meaningful use requirements as also meeting all e-prescribing and Physician Quality Report System (PQRS) requirements. Eligible professionals (EPs) who meet the meaningful use requirements should automatically avoid penalties for both e-prescribing and PQRS as well, MGMA says.

The association also is urging CMS to institute a formal appeals process for the e-prescribing program that would allow providers to contest both past and future penalties. CMS also should allow batch submissions of e-prescribing hardship exemption requests for group practice administrators with multiple EPs, and should provide more timely feedback so providers can monitor progress and make adjustments to correct quality code rejections they may not realize are happening at the time of claims submission, according to the letter.

The e-prescribing penalty program was established as part of the 5-year Medicare incentive program created under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) to promote the adoption and use of e-prescribing. The penalty phase begins this year and runs through 2014 for physicians who are eligible for incentive payments but do not e-prescribe. The penalty for failing to participate in the program or file for an exemption on time is a 1.5% payment reduction for all Medicare claims based on the 2013 fee schedule.

Exemptions are valid for doctors who:

are located in rural areas without high-speed Internet access;

have no available pharmacies for e-prescribing;

are unable to e-prescribe because of local, state, or federal regulations; or

write fewer than 100 prescriptions during a calendar year.

Doctors who fall into one of those categories have until June 30 to file for an exemption to the program. Exemptions must be filed online by physicians, not their staffs, and will not be accepted by mail, email, or fax.

June 30 also is the end of the CMS-imposed enforcement discretion period for entities covered by the Health Insurance Portability and Accountability Act to update to version 5010 standards.

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