Participating in the Medicare eRx Incentive Program

Table 1: Overview of the eRx incentives and penalties for 2012 through 2014

Table 1: Overview of the eRx incentives and penalties for 2012 through 2014

The deadline to file for a hardship exemption from the 2013 Electronic Prescribing (eRx) Incentive Program has passed, and by now surgeons should be thinking about the requirements for the next few years. The Centers for Medicare & Medicaid Services’ (CMS) eRx Incentive Program was authorized by the Medicare Improvements for Patients and Providers Act of 2008. 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 percent. The program is currently set to expire in 2015. This article addresses questions surgeons may have regarding remaining incentives and penalties for 2012–2014. (See Table 1 for an overview of the eRx incentives and penalties remaining for 2012–2014.)

Table 2: Incentives and penalties for eRx

Table 2: Incentives and penalties for eRx

What are the incentives and penalties under the eRx program?

Table 2  shows both the incentives and penalties for each year starting from 2012.

Do I still have time to qualify for the 2012 eRx bonus?

Yes, EPs can still qualify for the 2012 eRx payment incentive of 1 percent. To qualify, EPs must report electronically 25 times from January 1 to December 31, 2012, for denominator eligible visits (see Table 3  for the eligible denominator codes). Denominator eligible codes are composed of evaluation and management codes.

Table 3: eRx measure denominator codes (eligible cases)

Table 3: eRx measure denominator codes (eligible cases)

Is it too late now to avoid the 2013 eRx penalty for nonparticipation?

Yes, it is too late for health care professionals to avoid the 2013 eRx payment penalty of 1.5 percent of the Medicare Part B physician fee schedule amount for covered professional services if they did not do one of the following:

  • Report 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 but was submitted in conjunction with a billable, covered procedure not associated with a global period).
  • Apply for a significant hardship exemption to avoid the 2013 eRx penalty on the CMS website by June 30, 2012, and receive CMS approval (it may take close to 30 days after application for the exemption for CMS to notify EPs regarding approval). See Table 4, page 8, for a list of the 2013 and 2014 significant hardship exemptions.
  • Qualify for an automatic exemption from the eRx Incentive Program. EPs will be automatically exempt from the 2013 eRx Incentive Program penalty if they meet any one of the following criteria:
    • The EP was 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 denominator eligible codes (listed in Table 3) for dates of service from January 1 to June 30, 2012
    • At least 10 percent or more of the EP’s Medicare Part B physician fee schedule charges are not from denominator eligible codes (listed in Table 3) for dates of service from January 1 to June 30, 2012
    • 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 and June 30, 2012
Table 4: Hardship exemptions available for 2013 and 2014

Table 4: Hardship exemptions available for 2013 and 2014

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

To avoid the 2014 eRx payment penalty of 2 percent of the Medicare Part B physician fee schedule amount for covered professional services, health care professionals must do one of the following:

  • Report electronically 25 times for denominator eligible visits from January 1 to December 31, 2012.
  • 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 but must be submitted in conjunction with a billable, covered procedure not associated with a global period).
  • Apply for a significant hardship exemption by June 30, 2013, once the portal opens in early 2013. See Table 4, page 8, for a list of the 2014 significant hardship exemptions.
  • Be automatically exempt from the eRx Incentive Program. EPs will be automatically exempt from the 2014 eRx Incentive Program penalty if they meet any one of the following:
    • The EP is a successful electronic prescriber during the 2012 eRx 12-month reporting period of January 1 to December 31, 2012
    • The EP is not a MD, DO, podiatrist, nurse practitioner, or physician assistant by June 30, 2013
    • The EP does not have at least 100 Medicare Part B physician fee schedule cases containing denominator eligible codes (listed in Table 3) for dates of service from January 1 to June 30, 2013
    • At least 10 percent or more of the EP’s Medicare Part B physician fee schedule charges are not from denominator eligible codes (listed in Table 3) for dates of service from January 1 to June 30, 2013
    • 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, 2013

For more information on the eRx Incentive Program, continue to check the American College of Surgeons website at http://www.facs.org/ahp/erx.html or the CMS eRx website. For more information on payment penalties, visit the CMS Web page.

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.


*Centers for Medicare & Medicaid Services. Available at: https://www.cms.gov/Medicare/E-Health/Eprescribing/index.html. Accessed June 27, 2012.

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