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June 30th Deadline: eRX Tips

June 30, 2011 eRX G-code Tips:

  • The June 30 “deadline” is the date-of-service.  Therefore, claims with the eRX G-code and applicable visit codes for DOS from Jan. 1 – June 30 can be submitted before the end of July in regards to the eRX Incentive/Penalty program.
  • Claims cannot be re-submitted solely for the purpose of adding or correcting an eRX Gcode.
  • Prescribed over-the-counter and durable medical equipment count towards an eRX event if it is associated with an applicable visit code.
  • Electronically generated refills associated with an eligible face-to-face patient visit DO qualify as electronic prescribing. Electronically generated refills that are NOT associated with a face-to-face patient visit DO NOT qualify.
  • Proposed changes to eRX Incentive / Penalty program are under consideration which includes extending the deadline to submit an eRX hardship Gcode until October, 2011.  In addition, this proposed rule would exempt providers registered to participate in Medicare and Medicaid EHR Incentive programs.  This proposed rule has not been finalized, so it is advisable to submit applicable G-codes (10+ times to avoid the penalty or 25+ times to qualify for incentives) as defined in the current 2011 eRX program. 

Helpful Links:

June 21 – CMS National Provider Call: http://www.cms.gov/PQRS/04_CMSSponsoredCalls.asp#TopOfPage

http://www.cms.gov/ERxIncentive/

Remember, to avoid the 2012 penalty (1% of Medicare revenue) or the 2013 penalty (1.5% of Medicare revenue) each eligible provider will need to report at least 10 e-prescriptions for Medicare patients by June 30, 2011 on claims associated with an eligible patient visit.  The only other way to avoid penalties would be to submit an applicable ‘hardship code’ by June 30, 2011.  Please see CMS for additional ePrescribing information and definition of hardship codes.