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 eRxInformalReview@cms.hhs.gov. 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.
New exemptions for 2013 apply if:
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 firstname.lastname@example.org. Also engage at www.twitter.com/MedEconomics and www.facebook.com/MedicalEconomics.