Penalized in Error?

Last week I had the pleasure of attending the annual meeting of the Renal Physicians Association in Washington, DC. The cherry blossoms were radiant and, in spite of fantastic weather, the presentations were very well attended. Highlights of the meeting from my perspective included an excellent presentation by the AMA’s Nancy Spector regarding the ICD-10 transition (unfortunately she could not tell us when the new deadline would be announced) as well as a rousing leadership presentation by Harry Jansen Kraemer, the former CEO of Baxter International.


One of the many things I learned at the meeting relates to our old friend, the CMS e-prescribing penalty. As you probably recall, 2012 is the first year CMS is levying this penalty upon providers deemed unsuccessful electronic prescribers. There were several ways to avoid this penalty, which we reviewed in previous posts. At the meeting I learned that it’s possible, thanks to the AMA, to make an appeal if you feel you are being penalized inappropriately.


Quality Net “Help” Desk


The AMA has posted a two-page memo describing this opportunity and the RPA intends to do so as well. In summary, the process starts by contacting the CMS Quality Net Help Desk. You can reach them by phone at 866-288-8912 begin_of_the_skype_highlighting              866-288-8912     end_of_the_skype_highlighting or via email at


Recently I blogged about how to determine whether or not you are being penalized. If you are a provider facing the 2012 eRx penalty, you should immediately contact the Quality Net help desk if one of the following applies:

  1. You sent prescriptions electronically last year and applied the eRx G-code (G8553) to the appropriate number of Medicare Part B claims, but a technical glitch prevented the G-code from reaching Medicare. For example, if the claims clearinghouse you used removed the G-code from your Part B claims, this hardship would apply. In this case you must have documentation that you e-prescribed for your Part B patients.
  2. You sent one of the old eRx G-codes from the 2009 program with your Part B claims in 2011. Again, you will need to have documentation that you electronically prescribed for your Part B patients if this applies to you.
  3. You filed an exemption request (because you demonstrated meaningful use in 2011 for example) but you included your group NPI instead of your individual NPI on the exemption request, and as a result your request was denied.
  4. You filed for an exemption request but have either not heard from CMS or believe your request was denied in error.

If any of the above applies to you or someone within your practice, contact the folks at Quality Net ASAP. A 1% haircut on your Medicare Part B allowable may sound like a small trim, but these days every penny counts.


Have you had experience with the Quality Net Help Desk? If so, let us know how it went.

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