Avoid EHR Penalties with These Proposed Additional Exemptions

 Posted on 07. Jul, 2011 by rpandit in Hot Coding Topics, Provider News Check whether your group might fall into one of four new categories. The push toward e-prescribing is in full swing, with physicians possibly being subjected to a one percent paym...

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Avoid EHR Penalties with These Proposed Additional Exemptions

Check whether your group might fall into one of four new categories.

The push toward e-prescribing is in full swing, with physicians possibly being subjected to a one percent payment hit on CMS claims in 2012 if you don’t successfully participate in e-prescribing this year (and larger hits in 2013 and 2014). If your physicians haven’t yet met e-prescribing criteria, take hope: CMS has proposed four additional ways that eligible professionals (EPs) can potentially avoid the adjustment in 2012.

The imminent penalty for physicians who don’t e-prescribe “has created quite a bit of concern about circumstances where doctors will potentially be penalized, not necessarily because of failure to electronically prescribe, but more so because of some complexities with regard to the measurement,” said Michael Rapp, MD, JD, director of the quality measurement and health assessment group at CMS, during a May 26 CMS Open Door Forum.

Previously, physicians could apply for a hardship exemption only if they could prove a lack of access to the internet in their area or limited access to pharmacies that accepted electronic prescribing. Under the new proposal, EPs would be eligible to request a hardship exemption that CMS would determine on a case-by-case basis if they meet one of the following additional four criteria, Rapp said.

1. Registering With Intent to Adopt EHR Technology
Practitioners who intend to start participating in the HER (Electronic Health Record) Incentive Program might still be getting their technology in place, so they may not have e-prescribed ten times within the first six months of 2011, as is required to avoid the penalty. The new proposal aims to offer those practices a potential exemption.

2. Prescribing Meds That Legally Cannot Be Electronically Transmitted
Many state, local, or...

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CMS: Prove Your Exemption From the E-Prescribing Penalty With New G Codes

Even if you don’t have prescribing privileges, you can rest assured now as CMS will not cut your pay as a penalty for failing to comply with the new e-prescribing incentive program.

As you are probably aware, starting in 2012, you may be subject to a one percent payment adjustment on your Part B pay if you don’t successfully participate in e-prescribing this year. In 2013, that payment adjustment will go up to 1.5 percent, and in 2014 it will rise to two percent, CMS’s Daniel Green, MD noted on a Feb. 15 CMS-sponsored call.

“To earn an incentive in 2011, an eligible professional must e-prescribe 25 times during the year, ten of which must be in the first six months,” Green said. “If they are a successful e-prescriber during the calendar year, they not only would avoid the 2012 payment adjustment, they would get a one percent 2011 payment incentive, and they would be exempt from the 2013 payment adjustment,” he explained.

“Earning an incentive in 2011 does not necessarily exempt the eligible professional or group practice from a payment adjustment in 2012,” Green explained.

How to Avoid the Adjustment

CMS reps said that they’ve been flooded with calls about the 2012 payment adjustment, and described ways that you can avoid the adjustment if you qualify.

Not eligible to prescribe: If you are not a physician, nurse practitioner, or physician assistant between Jan. 1 and June 30, 2011, you can avoid the e-prescribing penalty. In addition, if you don’t have prescribing privileges at least once on a claim between Jan. 1 and June 30, 2011, you should append G8644 (Eligible professional does not have prescribing privileges) at least once before June 30 to ensure that your MAC knows you are not subject to the penalty, said CMS’s Michelle...

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CodingConferences Coding Changes Top Tips from Editor Leigh Delozier

600 coders, physicians, and office managers gathered in Orlando, Fla. for one and a half jam-packed days of education, networking, and shopping at the December 2011 Coding Update and Reimbursement Conference. Coders’ biggest struggle was absorbing all the information – and not overdoing the holiday buying. Experts offered the inside scoop on medical coding changes for 2011 and beyond. Here are my top picks:

  1. E-prescribing is here to stay – and is about to be more strictly enforced. Physicians need to e-prescribe at least 10 medications for patients during the first 6 months of 2011, or they’ll be added to the list for a 1% penalty hit in 2012. “The prescriptions can be for one patient ten different times, or can be spread out among different patients,” said Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, in “Take Steps Now to Prepare for 2011 Pain Management Changes”.  “For pain management practices, the prescriptions can be for any type of pain meds.”
  2. Three PQRI measures apply to anesthesia providers: timing of prophylactic antibiotic (measure 30); maximal sterile barrier technique (measure 76); and active warming/temperature (measure 193). You have three reporting options: measure 76 alone; measures 76 and 193; or measures 30 and 76 said Judith Blaszczyk, RN, CPC, ACS-PM. “You must report on 80% of qualifying cases,” she reminded during her workshop, “Take Steps Now to Prepare for 2011 Anesthesia Changes.”
  3. No matter how many years you’ve been coding, you’ve heard, “ICD-10 is on the way.” Now that it’s looming as a reality, take a deep breath and know that you’ll be OK. “We learned to use ICD-9, and we’ll learn to use ICD-10,” Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, said in “Diagnosis Coding for Anesthesia”. “We can do this! We are not afraid.”

This...

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Want to Integrate PQRI Measures Into Your Practice? Look Here.

Participation can put extra bread in your basket. Back again for 2010 is Medicare’s incentive-driven physician quality reporting initiative (PQRI), aimed at tracking quality metric or patient care services that physicians provide. When the practice treats enough patients in the same category, some PQRI dollars might be only a few codes away. If you know the basics [...] Related articles:

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