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2013 Hardship Codes and Hardship Exemption Requests to avoid eRx penalties


CMS may exempt individual eligible professionals and group practices participating in the eRx GPRO from the 2013 payment adjustment if it is determined that compliance with the requirement for being a successful electronic prescriber would result in a significant hardship.

Hardship Exemption Circumstances and Codes:

Inability to electronically prescribe due to state, or federal law, or local law or regulation;

The eligible professional prescribes fewer than 100 prescriptions during a 6–month payment adjustment reporting period;

The eligible professional practices in a rural area without sufficient high-speed Internet access (G8642); and

The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing (G8643).

Submitting a Hardship Request

CMS established the Quality Reporting Communication Support Page at http://www.qualitynet.org/pqrs for eligible professionals to submit hardship requests, including those associated with a G-code. 

For more information detailing how to navigate the Quality Reporting Communication Support Page, please reference the following documents:

“Quality Reporting Communication Support Page User Guide” posted on the QualityNet website at https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234 on the Internet; and   

“Tips for Using the Quality Reporting Communication Support Page” at http://www.cms.gov/ERxIncentive/20_Payment_Adjustment_Information.asp on the CMS website.

A hardship G-code may also be submitted at least once on a claim during the 6-month 2013 eRx payment adjustment reporting period, if applicable.

The hardship G-code must be submitted on a claim with a billable Medicare Part B service.

The hardship G-code does not need to be submitted on a claim that contains eRx measure denominator codes

Reference(s): http://cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1206.pdf

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