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Practice Fusion · May 15, 2013

Avoid the e-prescribe penalty

As a Medicare provider, you may be subject to federal penalties if you don’t send and report a certain number of e-prescriptions or qualify for an exclusion. You need to send 10 G-codes by June 30 in order to avoid a 2% Medicare deduction in 2014.

The CMS Medicare eRx Incentive Program is designed to encourage adoption of e-prescribing. All Medicare providers (subject to exceptions below) are required to report the $0 CPT-II code G8553 on at least 10 eRx claims to Medicare.

To avoid penalties:

  1. Activate your e-prescribing

  2. Send at least 10 electronic e-prescriptions from your EHR

  3. File the CMS-1500 Medicare claims with the G-code G8553 for 10 encounters with at least one e-prescription

Claims may NOT be resubmitted for the sole purpose of adding or correcting an eRx code.

You can skip to step three if you have already been e-prescribing. If you haven’t yet signed up for e-prescribing, make sure to do so soon since it takes several days for your signup to be processed. For detailed instructions on fulfilling the requirements, visit Knowledgebase.

You are excluded from the requirement if one of the following apply:

  • New for 2013: You achieved Meaningful Use under the Medicare or Medicaid EHR Incentive Program in 2012 or in 2013 and have attested before June 30, 2013

  • New for 2013: You have demonstrated intent to participate in the Medicare or Medicaid EHR Incentive Program by registering with CMS with an EHR certification ID and have adopted a certified EHR technology before June 30, 2013

  • You are not an MD, DO, podiatrist, Nurse Practitioner, or Physician Assistant as of June

  • You have successfully met the 25 G-code e-prescribing requirement in 2012

  • You don’t have at least 100 Medicare Part B PFS cases in 2013 as of June 30

  • You don’t have 10% or more of your Medicare Part B PFS allowable charges (per TIN) for encounter codes in 2013 as of June 30

  • You do not have prescribing privileges and report G8644 on a billable Medicare Part B service at least once on a claim in 2013 before June 30

  • You meet the hardship criteria. See the Knowledgebase for more details.

Visit the Practice Fusion Knowledgebase for more details about exclusions and hardship criteria.