Was I Assessed the 1 Percent ePrescribing Penalty?

We’ve heard from many physicians and practice administrators trying to make sense of their remittance advices to figure out if they were assessed the 1 percent penalty for failure to meet Medicare’s ePrescribing requirements.

So, how can you tell if you were assessed the penalty? Review your remittance advices for claims submitted for dates of service on or after January 1, 2012. If a 1 percent penalty was assessed, it will contain reason code 237 (legislated/regulatory penalty) or remark code N545.

While the Centers for Medicare and Medicaid Services (CMS) previously said it would confirm exemption status for any provider who filed an exemption, it has stopped doing this due to the high volume of exemption requests.

Due to the recent migration to version 5010, CMS further announced a Part B claims processing error in which the G codes associated with the ePrescribing program were inadvertently dropped from 2012 claims. To avoid a penalty in 2013, providers should make sure the N365 code appears on their remittance advices (this code indicates the ePrescribing code was received and correctly processed), in addition to sending at least 25 prescriptions electronically by Dec. 31, 2012, of which 10 must be submitted by June 30, 2012. If you are not seeing the N365 code on any 2012 claims you’ve submitted so far, they should be submitted for reprocessing no later than Feb. 24, 2012. CMS says the error has been fixed.

PAMED members who have questions about the ePrescribing incentive or penalty can contact our division of practice economics and payer relations at (800) 228-7823, ext. 2644.