E-prescribing penalties and incentives begin June 30

Tags: e-prescribing, penalty, incentive

E-prescribing penalties, incentives begin June 30

posted 04.26.12

Texas physicians have until June 30 to e-prescribe to avoid a 1.5 percent penalty on all 2013 Medicare Part B claims. If you do not already e-prescribe in your office, now is the time to begin. If you do not use an electronic health record system with e-prescribing capabilities, you can install a standalone e-prescribing system and still meet the approaching deadline.

Physicians must report e-prescribing via claims using G-code G8553 on at least 10 unique Medicare encounters by June 30 to prevent the penalty. Three prescriptions for one patient encounter will count as only one e-prescribing incident.


Physicians who report at least 25 times by Dec. 31 qualify for a 1 percent bonus of Medicare Part B claims and prevent the penalty in 2014. For more information, follow the instructions in TMA’s 2012 e-prescribing informational paper, or contact TMA HIT by e-mail at hit@texmed.org or by phone at (800) 880-5720.

If you need help with e-prescribing, TMA recommends physicians turn to the Texas regional extension centers. RECs provide support to physicians to help with e-prescribing, EHR selection, workflow analysis, staff training, EHR incentives, and more. Visit TMA’s Texas REC Resource Center for more information.

The Centers for Medicare and Medicaid Services has offered the e-prescribing incentive since 2009 to encourage the use of e-prescribing to improve the efficiency and safety of health care. E-prescribing is a way to prevent medication errors that arise due to difficulties in reading or understanding handwritten prescriptions.

If you plan to apply for the Medicare EHR incentive in 2012, note that you can’t receive the e-prescribing incentive in the same payment year. Physicians enrolled in the federal Medicare EHR incentive program can still be penalized in 2013 if they do not report 10 e-prescriptions via claims using G-code G8553. Physicians applying for the Medicaid EHR incentive are still eligible for e-prescribing incentive payments.

2012 Penalty

Physicians who did not e-prescribe and report the G-code at least 10 times by June 30, 2011, or did not apply for and receive an exemption are currently being penalized 1 percent of their Medicare Part B claims. Physicians who act this year will be made whole in 2013. There is no formal appeal or informal review process for the 2012 penalties. Physicians may submit all inquiries to the QualityNet Help Desk for CMS examination. Contact the help desk by phone at (866) 288-8912 from 7 a.m. to 7 p.m. Monday through Friday, or by e-mail at qnetsupport@sdps.org.