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Med-Pro Management, Inc.

Medical Practice Management and Consulting


June 2011 

In This Issue
CMS Proposes Exemptions to Medicare ePrescription Penalty Policy
Medicare Audits on the Rise
CMS Proposes Exemptions to Medicare ePrescription Penalty Policy

The Centers for Medicare & Medicaid Services (CMS) announced that it would modify the penalty policy for the Medicare ePrescribing Incentive Program. According to a proposed rule from CMS, the agency would add more exemption categories so physicians are not unfairly penalized in 2012 for failing to meet the requirements under the Medicare ePrescribing Incentive Program. 


To avoid the 2012 penalty, physicians can attest that they should be eligible for one of the following exemptions:

  • The physician's practice is located in a rural area without high-speed internet access.
  • The physician's practice is located in an area without sufficient available pharmacies for electronic prescribing.
  • The physician is registered to participate in the Medicare or Medicaid Electronic Health Records (EHR) Incentive Program and has adopted certified EHR technology.
  • The physician is unable to electronically prescribe because of local, state or federal law or regulation (such as prescribing controlled substances).
  • The physician infrequently prescribes (such as prescribing fewer than 10 prescriptions from January 1 to June 30).
  • There are insufficient opportunities to report the ePrescribing measure because of program limitations.
Physicians still are required to ePrescribe using a qualifying ePrescribing system and report the G8553 code on at least 10 Medicare Part B claims from January 1 through June 30 this year to avoid the 2012 penalty. If CMS's proposal is accepted, physicians interested in applying for an exemption from the 2012 penalty must do so by October 1, 2011. 

According to the Centers for Medicare & Medicaid Services (CMS), providers will be given an opportunity to access an on-line web-portal and file for an exemption.  Details about the web-portal will be announced shortly.


"Whenever you see a successful business, someone once made a courageous decision."

Peter Drucker      


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Medicare Audits On the Rise
The Center for Medicare & Medicaid Services (CMS) has directed its contractors to conduct audits of claims for improper payments.  Recently, claims paid in error have increased. According to Palmetto GBA, Medicare's contractor in California, California's error rate is at a high rate of 22%. The main reason for the claims paid in error is the lack of adequate documentation to support services billed.

According to Palmetto GBA,

"You control the documentation description what services your patients received, and your documentation serves as the basis for the bills sent to Medicare for the services you provided." 

In order to lower the claims error rate, Palmetto GBA will be undertaking an "aggressive approach" to address this issue and will increase the level and frequency or pre-payment and post-payment medical review of claims across all provider types and services.

Some of the insufficiencies found in provider documentation are as follows:
  • A provider's failure to respond to attempts to obtain medical records
  • Medical documents submitted do not contain pertinent patients's facts (patient's condition, diagnosis, etc.
  • Medical documentation is illegible, has no date, is improperly signed, etc.
The audits will be conducted by Palmetto GBA or one of several CMS payment review contractors:
CMS encourages providers to take a proactive approach to reviewing and improving documentation.  This requires a "team" effort.  MedPro can join your team and help you avoid unnecessary audits and penalties.
If you are interested to find out more about any of the topics mentioned, please do not hesitate to send us an email at or call us at (888) 549-1713.



Med-Pro Management, Inc.


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