What is eRX Limiting Charge?

The Medicare Fee Schedule for the year 2013 will have an additional column ‘eRX Limiting Charge’ that denotes “Limiting charge reduced based on status as an unsuccessful e-prescriber per the Electronic Prescribing (eRx) Incentive Program.”

Beginning on January 1, 2012, EPs who are not successful electronic prescribers are subject to a negative payment adjustment. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (P.L. 110-275) (MIPPA) requires the Centers for Medicare & Medicaid Services (CMS) to apply this negative payment adjustment to any EP who is not a successful e-prescriber under the eRx Incentive Program.

Specifically, Section 1848(a)(5)(A) of the Act states that:

“If the eligible professional is not a successful electronic prescriber for the reporting period for the year (as determined under subsection (m)(3)(B)), the fee schedule amount for such services furnished by such professional during the year (including the fee schedule amount for purposes of determining a payment based on such amount) shall be equal to the applicable percent of the fee schedule amount that would otherwise apply to such services under this subsection (determined after application of paragraph (3) but without regard to this paragraph).”

The negative payment adjustment applies to all EPs, regardless of whether the EP elects to be “participating” or “non-participating” for purposes of Medicare payments. The 2012 payment adjustment applies to all of the EP’s MPFS services and will result in the EP receiving 99% of the MPFS amount that would otherwise apply to such services during 2012. In other words, an EP receiving the negative payment adjustment would be paid 1% less than the MPFS amount for that service. In 2013, the negative payment adjustment increases to 1.5%, or payment of 98.5% of the MPFS amount for covered professional services furnished in 2013. In 2014, the negative payment adjustment is 2%, or payment of 98% of the MPFS amount for covered professional services furnished in 2014.

Reference: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7877.pdf