Participating in the Medicare eRx Incentive Program

The Centers for Medicare & Medicaid Services (CMS) Electronic Prescribing, or eRx, Incentive Program was authorized by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). CMS defines e-prescribing as “the ability to electronically send an accurate, error-free, and understandable prescription directly to a pharmacy from the point-of-care.” Eligible professionals (EPs) who successfully e-prescribe in 2012 can qualify for an incentive payment of 1.0 percent.

Table 1: Incentives and penalties under the eRx program

Table 1: Incentives and penalties under the eRx program

What are the incentives and penalties under the eRx program?

Table 1 on this page shows both the incentives and penalties for each year starting from 2012.

What do I need to do to qualify for the 2012 eRx bonus?

To qualify for the 2012 eRx payment incentive of 1.0 percent, EPs must report electronically 25 times from January 1 to December 31, 2012, for denominator eligible visits (see Table 2 on this page for the eligible denominator codes).

Table 2: eRx measure denominator codes (eligible)

Table 2: eRx measure denominator codes (eligible)

What steps should I take to avoid the 2013 penalties for nonparticipation?

To avoid the 2013 eRx payment penalty of 1.5 percent of the Medicare Part B physician fee schedule amount for covered professional services, EPs must meet the following criteria:

  • Have already reported prescriptions electronically 25 times from January 1 to December 31, 2011, for denominator eligible visits.
  • Report prescriptions electronically 10 times from January 1 to June 30, 2012, for any visit (which does not have to be associated with a denominator eligible code).
  • Apply for a significant hardship exemption to avoid the 2013 eRx penalty. The required form is available on the quality reporting communication support page, which can be found on the CMS website at https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234. Refer to Table 3 on page 6 for the hardship exemptions available for 2013. In addition, visit the ACS eRx website at http://www.facs.org/ahp/erx-exemption.pdf for step-by-step instructions on how to apply for hardship exemptions.
  • Be automatically exempt from the eRx Incentive Program. An EP will be automatically exempt from the 2013 eRx Incentive Program penalty if:
    • The EP is a successful electronic prescriber during the 2011 eRx 12-month reporting period of January 1 to December 31, 2011.
    • The EP is not a MD, Doctor of Osteopathic Medicine (DO), podiatrist, nurse practitioner, or physician assistant by June 30, 2012.
    • The EP does not have at least 100 Medicare Part B physician fee schedule cases containing an encounter code in the measure’s denominator for dates of service from January 1 to June 30, 2012. Refer to Table 2 for eligible denominators codes.
    • At least 10 percent or more of the EP’s Medicare Part B physician fee schedule charges are not from codes in the denominator of the measure for dates of service from January 1 to June 30, 2012 (refer to Table 2 for eligible denominator codes).
    • The EP does not have prescribing privileges and reported G8644 on a billable Medicare Part B service at least once on a claim between January 1 to June 30, 2012.
Table 3: Hardship exemptions available for 2013

Table 3: Hardship exemptions available for 2013

What should I do to avoid the 2014 eRx payment penalty?

To avoid the 2014 eRx payment penalty of 2.0 percent of the Medicare Part B physician fee schedule amount for covered professional services:

  • Report electronically 25 times for denominator eligible visits from January 1 to December 31, 2012. Refer to Table 2 for denominator eligible codes.
  • Report electronically at least 10 times from January 1 to June 30, 2013, for any visit (does not have to be associated with a denominator eligible code).

For more information on the eRx Incentive Program, continue to check the American College of Surgeons (ACS) website at http://www.facs.org/ahp/erx.html or the CMS eRx website at https://www.cms.gov/ERxIncentive/. For more information on payment penalties, visit the following CMS Web page: http://www.cms.gov/ERxIncentive/20_Payment_Adjustment_Information.asp.

If you have any questions, contact Sana Gokak, ACS Division of Advocacy and Health Policy, at 202-337-2701 or sgokak@facs.org. You may also contact the CMS eRx help desk at 866-288-8912.

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