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Review Medicare Remits for ‘LE’ eRX Payment Adjustment

All Medicare providers are encouraged to review remittance advices for all services rendered in 2012 to ensure that they are not receiving a 1% eRX payment penalty in error.


Due to high volume of hardship exemption requests, it is not feasible for CMS to provide 2012 eRX Payment Adjustment (penalty) feedback reports. CMS is strongly encouraging
all eligible providers to carefully review their 2012 remittance advice for all services rendered in 2012
. If a 1% payment adjustment is being taken in error, notify CMS immediately so they may reprocess the claims.

Look for “LE” on the remittance advise which indicates an eRX payment adjustment and the Claim Adjustment Reason Codes:

  • CARC 237 – Legislated/Regulatory Penalty
  • RARC N545 – Payment reduced based on status as an unsuccessful e-prescriber per eRX incentive program.

Also, note the 2012 eRX Incentive still requires the submission of 25, G-8553 on claims.  The 2012 eRX incentive payment will be applied separately from any eRX payment adjustment.

CMS Guide to Understanding eRX Payment Adjustment