Medical Billing Blog

Medical Billing E-prescribe Requirements for 2013

Posted by Ali Ziehm on Tue, Apr, 24, 2012 @ 12:04 PM

E-prescribe requirements for 2013Medical Billing requirements for Medicare's e-prescribe program are different this year from previous years.  To avoid the E-prescribe penalties in 2013, providers must successfully e-prescribe 10 times on eligible claims for service dates of January 1, 2012 through June 30, 2012 and that are processed by July 29, 2012.  This means the claims must fully negotiate the Medicare system and be paid prior to July 29, 2012, so it’s of paramount importance that providers make sure they are processing enough eligible claims to avoid the penalty.  Furthermore, we recommend that claims be submitted before the end of May, because Medicare traditionally begins holding claims in June so they can be paid in the third quarter.  Note that this suggested submission date is not a deadline leveled by Medicare, and there is no guarantee that claims submitted by the end of May will be processed by the end of July.  There is also no way to tell what other issues may come up with individual claims that may prevent them from being processed.  Therefore, professionals should try to e-prescribe on more than 10 claims to ensure that they meet the quantity threshold.

If a provider knows he cannot meet this requirement, he can arrange to apply for a hardship exemption from Medicare.  Hardship exemption applications are currently being accepted by Medicare for those who cannot E-prescribe for various reasons, including:

  • The eligible professional or group practice practices in a rural area with limited high-speed internet access;
  • The eligible professional or group practice practices in an area with limited available pharmacies for electronic prescribing;
  • Inability to electronically prescribe due to local, state, or federal law; or
  • Eligible professional who prescribes fewer than 100 prescriptions during a 6-month payment adjustment reporting period.

Penalties leveled in 2013 for those failing to meet these requirements includes a 1.5% decrease in reimbursements; however, those who e-prescribed successfully in 2011 may have already qualified to receive a bonus of 1% to be paid as a lump sum in the fall of 2012, and also avoid the 2013 payment adjustment.  If similar incentives are offered for 2014, it is certainly in the best interests of physicians to qualify for it by e-prescribing successfully in 2012.