Physicians who were unable to meet the Medicare ePrescribing program's requirements have until Nov. 1 to apply for a hardship exemption to avoid monetary penalties in 2012.

The Medicare ePrescribing penalty rule required physicians to issue and report at least 10 electronic scripts (e-scripts) during the first six months of 2011. Those who were unable to do so face a penalty that reduces their total 2012 Medicare payments by 1 percent.

In response to the AMA's request for greater flexibility, the Centers for Medicare & Medicaid Services released a final rule Aug. 31 that provided six exemption categories and extended the deadline for physicians to apply for an exemption by one month. Physicians may file an exemption if:

• Their practice is located in a rural area without high-speed Internet access.
• Their practice is located in an area without sufficient available pharmacies for ePrescribing.
• They are registered to participate in the Medicare or Medicaid electronic health record (EHR) incentive program and they adopted certified EHR technology by Oct. 1, prior to requesting an exemption.
• They are unable to ePrescribe because of local, state or federal laws or regulations. (CMS confirmed that physicians who mainly prescribe narcotics but cannot submit these prescriptions electronically because of certain limitations can apply for this exemption category.)
• They do not prescribe on a regular basis.
• There were too few opportunities for them to report the ePrescribing measure because of limitations of the measure's denominator. For example, they do prescribe electronically but their e-scripts are not related to qualifying visits or services.

The separate 2011 ePrescribing incentive program also is under way. An incentive of 1 percent of total 2011 Medicare allowable charges is available to physicians who prescribe and report at least 25 e-scripts by the end of 2011. These physicians will also avoid the 2013 penalty.

Find out how to issue and report e-scripts for the 2011 incentive and apply for a hardship exemption to avoid the 2012 penalty by viewing a free archived webinar from the AMA. This webinar covers incentives and penalties, attestation, exemption categories and prescribing controlled substances. (Note: If you have difficulty accessing the online application, email QualityNet, which runs the portal for CMS.)

Learn more about the Medicare ePrescribing program hardship exemptions and AMA advocacy efforts related to ePrescribing in the latest issue of Health System Reform Insight.

Last Revision: September 29, 2011