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CMS Issues Final Rule on E-Prescribing

September 6, 2011
by Mark Hagland
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Clarifications and exceptions are made around potential pay cuts to physicians

The federal Centers for Medicare and Medicaid Services (CMS) announced on Aug. 31 that it was adding a bit more flexibility to its requirements around electronic prescribing (e-prescribing), through its changes in a final rule on physician reimbursement on that date that modified earlier requirements in its proposed rule from May.

The earlier, proposed, rule had confirmed that physicians who use a qualified e-prescribing system will be eligible for an additional 1 percent in Medicare Part B payments in 2011 and 2012, and a 0.5 percent increase in 2013. On the other hand, doctors who failed to complete at least 10 paperless prescriptions using a qualified e-prescribing system between Jan. 1 and June 30 of this year were set to receive a 1 percent cut in Medicare pay in 2012, a 1.5 percent cut in 2013, and a 2 percent cut in 2014. Physicians in rural areas without sufficient high-speed access and those without sufficient available pharmacies were set to be exempt.

The final rule released last week gave physicians one extra month to apply for a hardship waiver to avoid being penalized; as of Aug. 31, they must apply by Nov. 1 for a hardship exemption.

In addition, physicians who are registered to participate in another electronic health records program—such as the Medicare or Medicaid EHR Incentive Programs under the Act—will also be exempt from the 1 percent reimbursement cut in 2012.

This second clarification or adjustment is particularly significant, as it means that physicians who have already registered to participate in either of those programs do not have to prove that they are successful e-prescribers, since that program already quires meaningful users to have e-prescribing capabilities.

In response to the release of the final rule, the nation’s largest physician association released a statement.

“The American Medical Association (AMA) appreciates changes made by the Centers for Medicare and Medicaid Services (CMS) that provide more flexibility under the Medicare e-prescribing program so that more physicians who are unable to meet all the program requirements can be eligible and apply for an exemption to avoid penalties in 2012,” said the statement, issued by Cecil B. Wilson, M.D., the Chicago-based association’s immediate past president. “However, the AMA remains concerned that physicians only have a short period of time to apply for an exemption once CMS’s Web-based tool is made available.”

The statement went on to say that “[W]e had hoped for even greater flexibility, including an additional reporting period. We remain concerned that physicians will be hit with a penalty and are not being given enough time to comply with the e-prescribing program criteria to avoid this penalty.”

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