Electronic Prescribing Adjustment for 2012

A recent Special Edition Article MLN Matters, Number SE1141, answers many of the questions raised about the 2012 adjustment for those providers who were not successful E-prescribers and not otherwise excluded.

Eligible professionals who did not meet the required criteria for E-prescribing will receive 99% (1% penalty) of their Medicare Part B allowed dollars from January 1 – December 31, 2012. The term “LE” will be on their Remittance Advice for all services as well as an adjustment reason code and remittance advice remark code. They will read as follows:

  • CARC 237 – Legislated/Regulatory Penalty
  • RARC N545 – Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing Incentive Program.

The 2011 bonus will be handled as a separate event from the payment adjustment. It is possible that a provider may be penalized in 2012 but still receive a 2011 bonus. Eligible professionals who did not submit ten or more electronic prescriptions in the first six months of 2011 will be penalized. Those same providers may have implemented a system and met the required 25 prescriptions by year’s end and still secure the 1% 2011 bonus.

Providers who practice in more than one location may find that they are penalized in one location and not in another. Program participation is by NPI number and links to the tax identification number of the practice. Some physicians were successful in some but not all practices where they work.

Nonparticipating providers subject to the payment adjustment are instructed to contact their Part B contractor for instruction on how the adjustment will be applied to their limiting charge.

The complete MLM article can be found at: http://www.cms.gov/MLNMattersArticles/Downloads/SE1141.pdf

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