CPT Exemption

Hardship CPT Exemption

Can I submit a significant eRx hardship exemption request on behalf of a provider in my office?

No, you may not. Billing managers, office managers, receptionists, and other office staff cannot submit an eRx hardship exemption request on behalf of their eligible professionals for the 2012 eRx payment adjustment.The Tax Identification Number/National Provider Identifier (TIN/NPI) requesting the significant hardship exemption must be the one who enters the request by November 1, 2011.

When accessing the Quality Reporting Communication Support Page at http://www.qualitynet.org/pqrs to submit the hardship exemption request, the requestor relationship must be the “health care provider”.Please note, however, that you or office staff can use the Quality Reporting Communication Support Page to submit a request for an NPI-level feedback report on behalf of the eligible professional.

For any questions or concerns, please contact the QualityNet Help Desk at 866-288-8912 (TTY 877-715-6222) from 7:00 a.m.-7:00 p.m. CST Monday through Friday or via e-mail to Qnetsupport@sdps.org.

Do each Providers in a group need to request hardship exemption individually?

Yes. If an entire group needs to request a hardship, the request must be submitted for each National Provider Identifier (NPI)/Tax Identification Number (TIN) within the group. The hardship cannot be requested on behalf of a group.

Submitting a hardship request will not prevent you from receiving a bonus check if you actually qualified.

Will Providers receive any confirmation from CMS?

Once you have submitted a hardship request, you will receive a confirmation e-mail stating that CMS has received your request. CMS will review your request and send a follow up e-mail or letter indicating whether you were approved or not. If you do not receive the initial confirmation e-mail, please contact QualityNet for further instructions at (866) 288-8912.

How many reason may be selected in the hardship request form?

When completing the hardship request form, only one reason for the hardship can be selected. However, CMS strongly recommends that you provide as many details relating to the hardship request as possible in the “Justification for Hardship” section. Multiple issues and reasons can be added in this section to assist CMS with their review.

Will interim feedback reports be available for the 2011 Electronic Prescribing (eRx) Incentive Program?

Yes, there will be an interim report for the 2011 eRx Incentive Program, but the focus will be on the 2012 eRx payment adjustment. It will be called the 2012 eRx Payment Adjustment Feedback Report. CMS will issue 2012 eRx payment adjustment feedback reports to all eligible professionals who submitted at least one denominator-eligible claim during the 6-month eRx payment adjustment reporting period of January 1-June 30, 2011, as well as for GPROs (Group Practice Reporting Option) who self-nominated and were selected to report the eRx measure as a group. It is anticipated that the reports will be available in the October/November 2011 timeframe.

2012 eRx Payment Adjustment Feedback Report will assess:

· Eligible claims;

· Minimum thresholds (100 cases and 10% allowed charges threshold);

· Number of valid G8553 codes received (10 required); and

· Any reporting (G8644) or hardship CPT Exemption (G8642, G8643) codes received.

The feedback report will show if the provider will or will not be subject to the 2012 eRx Payment Adjustment. However, this report will not indicate a participant’s incentive eligibility for the 2011 eRx Incentive Program.

Eligible professionals can access individual National Provider Identifier (NPI)-level reports through their Carrier/Medicare Administrative Contractor (MAC), or via a new Quality Reporting Communication Support Page when it becomes available at http://www.qualitynet.org/pqrs.

Taxpayer Identification Number (TIN)-level reports (which include NPI-level data), and GPRO reports will be available on the Physician and Other Health Care Professionals Quality Reporting Portal (Portal) at http://www.qualitynet.org/pqrs and will require an Individuals Authorized Access to CMS Computer Services (IACS) account. For instructions on how to create an IACS account, please refer to the Quick Reference Guides linked from the public page of the Portal.

For further questions or assistance with IACS and Portal access, please contact the QualityNet Help Desk at 866-288-8912, TTY 877-715-6222, or via e-mail at qnetsupport@sdps.org.

The 2012 eRx Payment Adjustment Feedback Report will be based strictly on analysis of claims data for the January 1-June 30, 2011 reporting period. If this report shows a provider as being subject to the 2012 eRx payment adjustment based upon the 6-month claims analysis, but the provider also requests and is approved for one of the new hardship exemptions in the summer/fall of 2011, the new hardship exemption will override the 6-month feedback report determination, and the provider will not be subject to the 2012 eRx payment adjustment.

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