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You can request reconsideration if you're getting dinged with a 2% Medicare eRx penalty



February 04, 2014
Area(s) of Interest: Payor Issues and Reimbursement Practice Management Public Payors 

Physicians and group practices who were not successful electronic prescribers under the 2012 or 2013 Medicare eRx Incentive Program will be subject to a negative payment adjustment of 2 percent in 2014 on all Medicare Part B claims paid under the physician fee schedule.


The Centers for Medicare and Medicaid Services (CMS) has notified physicians and group practices that did not meet the requirements and will be subject to the 2014 payment adjustment. Some practices have reported that their meaningful use attestation was not taken into consideration as an exemption. If this has impacted your practice, you must request a review.


If you believe this determination to be in error, CMS has implemented an informal review process through which reconsideration can be requested. Informal review requests will be accepted through February 28, 2014, and can be submitted via email only to eRxInformalReview@cms.hhs.gov. CMS will make an informal review decision within 90 days of the original request. Please note that the informal review decision will be final, and there will be no further review or appeal.


For complete instructions on how to submit an informal review request, see CMS's "2014 eRx Payment Adjustment Informal Review Made Simple."


Questions about the eRx Incentive Program can be directed to the CMS QualityNet Help Desk at (866) 288-8912 (TTY 877-715-6222) or qnetsupport@sdps.org.

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