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ODs exempt from eRx penalties

May 24, 2012

Optometrists, like many other health care professionals, can earn Medicare payment bonuses for prescribing pharmaceuticals electronically; however they will not be subject to Medicare payment reductions for failure to e-prescribe (eRx), according to the U.S. Centers for Medicare & Medicaid Services (CMS).

Under its Medicare Electronic Prescribing Incentive Program, the CMS this year began reducing the reimbursements of most health care practitioners who did not e-prescribe over the course of the previous year. The agency plans to continue docking the payments of non-e-prescribing practitioners at least through the end of 2014. However, the downward payment adjustments will be restricted to doctors of medicine, doctors of osteopathy, podiatrists, nurse practitioners, and physician assistants, the CMS emphasized when it announced its 2012 Medicare fee-for-service reimbursement rules earlier this year.

The move is designed to encourage the implementation of e-prescribing systems across the health care system by making incentives available to as wide a wide range of health care practitioners as possible without subjecting them to penalties if they cannot appropriately use their eRx systems at the levels anticipated under the incentive program, CMS officials said.

“In general, we believe that an incentive should be broadly available to encourage the widest possible adoption of electronic prescribing, even for low-volume prescribers. On the other hand, we believe that a payment adjustment should be applied primarily to assure that those who have a large volume of prescribing do so electronically, without penalizing those for whom the adoption and use of an electronic prescribing system may be impractical given the low volume of prescribing,” CMS officials said in their Federal Register notice.

The rule could potentially save some optometrists who do not generally prescribe pharmaceuticals, or do not prescribe them electronically, hundreds of dollars in Medicare payment penalties, the AOA Advocacy Group noted. The CMS plans to reduce payments to non-e-prescribers by 1 percent in 2012, 1.5 percent in 2013; and 2 percent in 2014.

However, the exemption has been the source of some concern for the AOA Washington office. The AOA Advocacy Group fears the rule could serve to undermine the status of optometrists as Medicare-recognized physicians, who under federal law must be reimbursed by the government health plan for all covered services within their scope of practice at the same reimbursement levels as other practitioners who might provide those services.

Even without the exception provided in this year’s Medicare payment policy rule, most optometrists would have avoided the payment reductions by using a special billing code to indicate they do not have prescriptive authority or applying for a hardship exemption, allowable under the incentive program, AOA Advocacy Group staff notes.

The Medicare Program, Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for Calendar Year 2012 can be accessed online at www.gpo.gov/fdsys/pkg/FR-2011-11-28/html/2011-28597.htm.

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