Neurologists May Still Face 1-Percent Payment Adjustment After Submitting Exemption

February 21, 2012

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Neurologists who applied for a hardship exemption by November 8, 2011, to avoid the 2012 payment adjustment for the Medicare Electronic Prescribing (eRx) Incentive Program, may still be seeing a 1-percent reduction to Medicare payments due to requests still pending or listing a group national provider identifier (NPI) versus your individual NPI on the exemption request.

Neurologists who are part of the thousands of unprocessed hardship exemptions will face the reduction until their exemption is finalized. The Centers for Medicare & Medicaid Services (CMS) will then reprocess all of the claims that received the payment adjustment following an exemption approval. A timeline for when all exemptions will be processed has not been released.

Neurologists who reported the hardship exemption using the practice's group NPI also may be facing a 1-percent reduction, even with a valid exemption explanation. Providers were required to list their individual NPI to be considered for the exemption. However, if the practice was participating in the Group Practice Reporting Option (GPRO) I or II part of the Medicare eRx Incentive Program the exemption would be okay with the group NPI number. While this issue was a major cause for exemption denials, the chance of a fix is slim, according to CMS.

For more information on the incentive program, go to the AAN's Medicare Electronic Prescribing web page.