You will pay the price if you do not meet e-prescribing requirements


This month's question focuses on the negative consequences of not meeting e-prescribing requirements. Find out the answer to this pressing coding question.

Q: Our office has been involved in the electronic prescribing (e-prescribing) program, but we’re not sure if we are capturing all our e-prescribing claims. What can we do to make sure that we’re following all of the requirements?

A: Starting this year, Medicare will take a 1.5% payment adjustment if you fall short of e-prescribing requirements. If you are subject to the reduction, the Centers for Medicare and Medicaid Services (CMS) will mail a letter to you that will give you two options:

1.Request an informal review.

If you believe your individual provider submitted e-prescriptions correctly by June 30, 2012, you have through February 28 to request an informal review. CMS will provide written notification of its decision.

Before you request a review, confirm that you included G8553 on the claims you submitted to CMS, and look for the N365 remark code on your remittance advice for confirmation that CMS received the G code. You then can request your informal review via email at Be sure to include each of your providers’ individual national provider identifier (NPI)-not a group NPI, and an email address, telephone number, and mailing address.

2.Submit a hardship request.

If you meet one of the applicable exemptions, you can submit a hardship request before January 31 via the Quality Reporting Communication Support Web site. When doing so, use individual, not group, NPIs.

Exemptions include:

  • you are not able to e-prescribe because of state, federal, or local regulations;

  • you are an eligible professional prescribing fewer than 100 prescriptions during a 6-month payment adjustment reporting period;

  • you’re an eligible professional practicing in a rural area without sufficient high-speed Internet access; or

  • you’re an eligible professional practicing in an area without sufficient pharmacies equipped to accept e-prescriptions.

New exemptions for 2013 apply if:

  • you attest to meaningful use of electronic health records (EHRs) or register to participate in meaningful use by January 31;

  • you achieve meaningful use during certain e-prescribing timeframes (January 1, 2011, through June 30, 2012, and attest by January 31); or

  • you register for the EHR incentive program by January 31 and enter the entire EHR certification number to receive the exemption.

The author is a billing and coding consultant for VEI Consulting Services, Indianapolis, Indiana. Do you have a primary care-related coding question you would like to have our experts answer in this column? Send it to Also engage at and


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