decisionhealth Newsletters, Part B News - 2012 Issue 3 (March)
Providers wrongfully hit with 1% e-Rx penalty must call MAC, QualityNet for possible reversal
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Article Overview
This article covers a Medicare payment issue affecting the e-Prescribing Incentive Program, focusing on how providers and practices can pursue informal review when they believe a penalty was applied in error. It is relevant to physicians, practice managers, billing staff, and compliance professionals who need to understand the roles of CMS, Medicare administrative contractors, QualityNet, and professional societies in resolving exemption and payment discrepancies.
Why This Topic Matters
The piece addresses potential revenue loss tied to an e-prescribing penalty and explains where providers may turn when formal appeals are unavailable. It is useful for practices trying to understand how to document discrepancies and escalate unresolved issues through the appropriate channels.
Article Sections
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E-prescribing
Introduces the payment issue involving the e-Prescribing Incentive Program and the parties involved in reviewing disputed penalties and exemptions.
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3 tips to recover your 1% penalty
Summarizes the practical topics covered for providers seeking review of a disputed penalty, including documentation, contact points, and support resources.
What You Will Learn
- How the article frames the e-prescribing penalty issue for providers and practices
- Which organizations are involved in reviewing disputed exemption and penalty situations
- What general types of documentation and follow-up are discussed for unresolved payment discrepancies
- How professional societies are described as helping escalate provider concerns
Who Should Read This
- Physicians
- Medical practice managers
- Billing and reimbursement staff
- Compliance professionals
- Quality reporting staff
Codes Discussed
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