June 2013 Client Newsletter

e-prescribing penalty

For those subject to the Centers for Medicare & Medicaid Services (CMS) e-prescribing penalty, June 30 was the last day to submit a hardship exemption, or report 10 instances before June 30, 2013 of e-prescribing on claims to CMS to avoid next year's 2 percent payment reduction. Electronic Prescribing (eRx) is a requirement for any Eligible Professional (EP) who provides services to Medicare Part B Fee-for-Service beneficiaries. EPs who are not successful electronic prescribers during 2012 or in the first six months of 2013 will receive only 98 percent of his/her Medicare Part B PFS amount for covered professional services in 2014 (a 2 percent payment adjustment).

EPs have already satisfied the criteria to avoid the payment adjustment if they have:

• Achieved Meaningful Use under the Medicare or Medicaid EHR Incentive Program during the 12-month eRx reporting period January 1, 2012 to December 31, 2012, or achieves Meaningful Use during the six-month eRx reporting period January 1, 2013 to June 30, 2013.

• Reported G8553 for at least 25 Medicare Part B eRx encounters during 2012

• Participate in an eRx GPRO practice

Providers who are penalized will see this reduction on each Medicare Part B claim as it is processed Jan. 1 through Dec. 31, 2014.

Medicare Meaningful Use penalties begin soon

The American Recovery and Reinvestment Act of 2009 (ARRA), requires penalties for Medicare eligible professionals (EPs) who are not meaningful users of Certified EHR Technology under the Medicare EHR Incentive Programs beginning in 2015. The reporting period for avoiding this penalty will vary based on when the EP began successfully attesting in the program:

• EPs who first attested to meaningful use in 2011 or 2012 must demonstrate meaningful use by successfully attesting for a full calendar year in 2013 to avoid payment adjustments in 2015;    

• EPs who first attested to meaningful use in 2013 must demonstrate meaningful use by successfully attesting for a 90-day reporting period in 2013 to avoid payment adjustments in 2015; and    

• EPs who first attested to meaningful use in 2014 must demonstrate meaningful use by successfully attesting for a 90-day reporting period in 2014 to avoid payment adjustments in 2015. This reporting period must occur in the first 9 months of calendar year 2014, and EPs must attest no later than Oct. 1, 2014, in order to avoid the payment adjustments.

Providers subject to the EHR Incentive Program penalties must continue to demonstrate meaningful use each year to avoid penalties in future years. For more information, visit the Medicare Meaningful Use Resource Center.

Sunshine rule

The Physician Payments Sunshine Act was included as part of the Affordable Care Act. Final regulations spelling out the details of the program, which the Centers for Medicare & Medicaid Services (CMS) now refers to as "OPEN PAYMENTS," were released earlier this year.

The law and regulations require certain drug, device, biological and medical supply manufacturers to report to CMS any payments or other value transferred to physicians or teaching hospitals. They also require reporting of physician ownership in manufacturers or group purchasing organizations (GPOs). Manufacturers will begin collecting information beginning Aug. 1, and information for 2013 will be made public on Sept. 30, 2014.

HHS revokes meaningful use EHR certification

The Department of Health and Human Services (HHS) revoked the certification for two EHR products, EHRMagic-Ambulatory and EHRMagic-Inpatient, previously certified to be used as part of the Medicare and Medicaid Meaningful Use EHR Incentive Programs. HHS announced that the products do not meet standards and providers cannot use these products to meet the requirements of the programs. The EHRs must be certified by an authorized certification body before regaining certification. Under these incentive programs eligible professionals (EPs) can earn up to $44,000 over five years under the Medicare portion of the program or up to $63,750 under Medicaid. Those EPs who are not meaningful users of certified EHRs face Medicare penalties starting in 2015.