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CMS Including E-Prescribing Penalty Status on Medicare Remittance Advice

Physicians can determine if they are being penalized in the 2012 Medicare e-prescribing incentive program by reviewing their Medicare remittance advice, according to the Centers for Medicare and Medicaid Services (CMS). Ophthalmologists who did not participate in the e-prescribing program in 2011, or who have not been exempted from the program by CMS, will begin seeing a 1 percent reduction in their Medicare fee-for-service payments this year. CMS originally intended to notify physicians of their e-prescribing penalty status through feedback reports. The remittance advice will include the code “LE” and the following remark codes:

  • CARC 237 – Legislated/Regulatory Penalty
  • RARC N545 – Payment reduced based on status as an unsuccessful e-prescriber per the Electronic Prescribing (eRx) Incentive Program

CMS continues to review requests from physicians for significant-hardship exemptions from the 2012 penalty. As CMS processes the exemption requests, the agency will notify physicians of their status through the contact information provided with the exemption request. In cases where a physician has already been penalized, but is later determined to be exempt, CMS will reprocess the penalized claims. Penalized ophthalmologists can avoid the 1.5 percent penalty in 2013 by beginning to e-prescribe now. More information on the e-prescribing program requirements is available on the Academy website.




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