Trick or Treat: The 2012 eRx Payment Adjustment Feedback Report Is Here

With Halloween one week away, the deadline for submitting an eRx hardship exemption is just around the corner (November 1). I’ve blogged about this “adjustment” several times in the past. Most recently I described the process for submitting one of the hardship exemptions. From my perspective, the hardship exemption most applicable to nephrologists is the one that pertains to nephrologists demonstrating meaningful use in 2011. The requirements state that the provider must file for this exemption (not a surrogate such as an office manager). Doing so takes less than 10 minutes if you have the necessary information in hand including your certified EHR’s ID number and your meaningful use registration number. The web page to request your exemption is here.

 

What’s new for Halloween?

When you file a hardship exemption or if you simply have an interest in learning where you stand from the perspective of the 2012 eRx penalty, you can ask CMS to provide you with the 2012 eRx Payment Adjustment Feedback Report. You’ll want to request this report as it displays pertinent information CMS has collected during the 2012 eRx adjustment reporting period (Jan 1 – June 30, 2011). Within the report you will find the following information:

• The eRx reporting denominator, which is the number of eligible Medicare Part B encounters the provider had during the first six months of this year. (If you had less than 100 eligible encounters during the first six months of this year, you are excluded from the penalty in 2012.)
• The number of eRx G-codes reported, including G-codes submitted for ineligible encounters.
• The number of valid G-codes submitted (remember 10 of these were required during the first six months of this year to avoid the 2012 penalty).
• The provider’s “threshold percentage.” This is a reflection of the 10% hurdle, which states that in order to be eligible for the incentive and the penalty at least 10% of the provider’s Medicare Part B allowable during the reporting period must originate from CPT codes in the eRx measures denominator. Of interest, almost 20% of the nephrologists who submitted a G-code in 2009 did not clear this hurdle.
• And last, but not least, whether the provider will be subject to the eRx adjustment.

 

How do I get to this information?

There are essentially two ways. A practice may request a tax ID number (TIN) level report which will display the information for every provider submitting Medicare Part B claims using that TIN. Those are available on the Physician and Other Healthcare Professionals Quality Reporting Portal. This requires obtaining an IACS account (Individuals Authorized Access to CMS Computer Services account). Per CMS, each TIN will receive only one report.

 

Nephrologists may also submit a request for an NPI level report via a link from the same page on the portal without the hassle factor that sometimes accompanies pursuing an IACS account (direct link here). I have not had experience with the TIN level request; however, the NPI level request was simple to create and the response from QualityNet was very fast. I received the report by email within 48 hours.

 

Halloween is indeed soon upon us. Youngsters are selecting costumes and have visions of bags full of treats. From my perspective the 2012 eRx Payment Adjustment Feedback Report should be viewed as a treat—take full advantage of it while you can.