subject: Use New G Codes to Show Your Exemption [print this page] Use New G Codes to Show Your Exemption Use New G Codes to Show Your Exemption
If you don't have prescribing privileges, you need not worry. This is because CMS will not cut your pay as a penalty for failing to comply with the just-in e-prescribing incentive program.
Starting 2012, you may be subject to a one percent payment adjustment on your Part B pay if you do not successfully participate in e-prescribing this year. In 2013, that payment adjustment will go up to 1.5 percent, and in 2014 it'll go up to two percent.
In order to earn an incentive this year, an eligible professional must e-prescribe 25 times during the year, 10 of which must be in the first six months. If they're 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'd be exempt from the 2013 payment adjustment.
Remember: Earning an incentive this year doesn't necessarily exempt the eligible professional or group practice from a payment adjustment in 2012.
How to avoid the adjustment
According to CMS reps, they have been flooded with calls about the 2012 payment adjustment, and described ways that you can avoid the adjustment if you qualify.
Not qualified to prescribe: If you're not a physician, nurse practitioner or physician assistant between January 1 and June 30 this year, you can avoid the e-prescribing penalty. Moreover, if you do not have prescribing privileges at least once on a claim between January 1 and June 30 this year, you should append G8644 (Eligible professional doesn't have prescribing privileges) at least once prior to June 30 to ensure that your MAC knows you are not subject to the penalty.
What's more, if you do not have at least 100 cases containing an encounter code in the measure denominator prior to June 30 or you do not meet the 10 percent denominator threshold, you could be excused from the penalty.
Hardship exemption: On a case by case basis, CMS may exempt an eligible professional (EP) from the payment adjustment if compliance with the requirement for being a successful electronic prescriber would end up in a significant hardship. For the 2012 eRx payment adjustment, if the EP practices in a rural area with limited high-speed internet access or in an area with limited available pharmacies that can receive electronic prescriptions, they could qualify for the hardship exemptions. In order to tell your MAC that you meet one of these exemptions, you'd need to report one of the following G codes:
G8642
G8643 Awaiting 'meaningful use'? Here's how to proceed One caller to the forum enquired whether her practice should move forward with e-prescribing to avoid the 2012 adjustment, even though her practice most likely will not demonstrate 'meaningful use' of an e-prescribing system until after the June 30 deadline has passed. Irrespective of your intent to take part in the meaningful use program, if you do not do at least 10 e-prescriptions in the first six months of this year, your doctor will get a payment adjustment beginning in 2012. As such, you should see to it that you meet the e-prescribing criteria now, even if you won't display meaningful use until July. For more on e-prescribing program and for other medical coding updates, stay tuned to a one-stop medical coding guide like Supercoder.
