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December 27, 2011

Article: CMS Will Not Provide Interim Feedback Reports for Determining if Individual Providers will Incur the 1% 2012 ERx Penalty for Medicare Part B Fee Schedule Services
   Despite CMS indicating in their 9/6/11 final E-Prescribe rules that providers would receive an interim feedback report to know in advance if they would receive the 1% ERx penalty adjustment as of 1/1/2012, CMS announced 12/20/11 these reports were not "technically feasible" for them to provide.
   In addition, CMS has NOT processed the ERx exemption requests which providers could apply for using the Communication Support Page up until 11/8/11. CMS indicates the volume of these requests was too great. The ONLY email notices thus far sent to providers as a result of their exemption request filings, were sent to providers from QualityNet on 12/9/11. The email notified providers they would not be penalized as of 1/1/2012; BUT WAS NOT due to the actual exemption request reason the provider filed. The email was sent to providers whose actual data had been reviewed for the period 1/1/11 thru 6/30/11 based on the Name/NPI/TIN listed in the exemption request; and determined they were already exempt from the penalty (no filing of an exemption request was required). The email sent to providers was VERY confusing. Here is what the email said:
   "Thank you for submitting a request for a significant hardship exemption from the 2012 electronic prescribing (eRx) payment adjustment. Our records indicate that you submitted one or more requests for a significant hardship exemption to the 2012 eRx payment adjustment. This formal notification is to inform you that the 2012 eRx payment adjustment, which will result in a 1.0 percent reduction on an eligible professional’s 2012 Medicare Part B physician fee schedule covered professional services, does NOT apply to you based on the identifying information received in your hardship request. Therefore, your request(s) for a significant hardship exemption to the 2012 eRx payment adjustment will be disregarded.
   If you received the above email...GREAT!! If you did not, then you will NOT receive any notification as to your penalty status that kicks in as of 1/1/2012, although CMS says they contunue to work on a method for notifying providers. At this late date, do not hold your breath.
   Instead, your first indication as to receiving the 1% penalty will occur when you start receiving your 2012 Medicare remittances. On 12/21/11, CMS posted an article describing the remittance and remark codes that will indicate the 1% penalty has been applied. To read the Medlearn article, click here.
   If the exemption request you filed on the Communication Support Page is ultimately approved by CMS after 1/1/2012, any claims where the penalty applied would then need to be re-processed thus creating further chaos to your patient account reconciliation. The MedLearn article also describes the remittance and remark codes you will see when the ERx penalty is subsequently adjusted.

 
 
 


 
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