CorporateBusiness Services

February 9, 2012

Electronic Prescribing (eRx) Incentive Program Updates

The Medicare Electronic Prescribing (eRx) Incentive Program, which began January 1, 2009 and is authorized under the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, provides incentives for eligible professionals who are successful electronic prescribers. A Web page dedicated to providing all the latest news on the eRx Incentive Program is available on the Centers for Medicare & Medicaid Services (CMS) websiteExternal Website.

Under section 1848(a)(5)(A) of the Social Security Act, for years 2012 through 2014, a Physician Fee Schedule (PFS) payment adjustment applies to eligible professionals who are not successful electronic prescribers at an increasing rate through 2014. Specifically, if the eligible professional is not a successful electronic prescriber for the respective reporting period for the appropriate program year, the PFS amount for covered professional services during the year shall be a percentage less than the PFS amount that would otherwise apply.

This Fact Sheet contains information about changes to the eRx Incentive Program for 2012 and future payment adjustments as authorized by MIPPA.

Changes for the 2012 eRx Incentive Program
The following are key changes for the 2012 eRx Incentive Program: Group Practice Reporting Option (GPRO) changes

Group Practices Participating in eRx GPRO
Group practices (who self-nominated and were selected by CMS to participate in the Group Practice Reporting Option) can qualify to earn an eRx incentive if it is determined that the practice is a successful electronic prescriber.

  • This incentive payment is equal to 1.0 percent of the total estimated Medicare Part B PFS allowed charges under the group practice's Taxpayer Identification Number (TIN)
  • The minimum number of times a group must report the eRx measure is:
    • 2,500 for large group practices participating in eRx GPRO participants (100 or more individual eligible professionals)
    • 625 for small group practices participating in eRx GPRO (25-99 individual eligible professionals)

Important Changes for the 2013 eRx Payment Adjustment 
The following are key changes for the 2013 eRx payment adjustment

  • Added a second reporting period to avoid the 2013 eRx payment adjustment (6-month reporting period, January 1-June 30, 2012)
    • Eligible professionals can report on any billable Medicare Part B PFS service to avoid the 2013 payment adjustment
    • Hardship exemption requests are available for eligible professionals who are unable to report the eRx measure 

Avoiding the 2013 eRx Payment Adjustment
In order to avoid the 2013 payment adjustment, eligible professionals are now able to report the eRx Quality-Data Code (QDC) on any billable Medicare Part B PFS service. In previous program years, events could only be reported with specified encounter codes. Please note that reporting denominator-eligible events is still required to earn an incentive payment for 2012.

Additional information on how to avoid future eRx payment adjustments can be found in the Electronic Prescribing (eRx) Incentive Program - Future Payment Adjustments document located on the CMS eRx websiteExternal Website, under the 'Educational Resources' section.

2012 Hardship Exemption Requests to Avoid the 2013 Payment Adjustment 
Individual eligible professional requesting hardship exemptions from the 2013 eRx payment adjustment will be able to submit their request using the CMS Quality Reporting Communication Support PageExternal Website. CMS will announce when the Quality Reporting Communication Support Page becomes available for requesting a hardship exemption for the 2013 eRx payment adjustment.

For more information on the 2012 eRx hardship exemption categories and on the process for requesting an exemption visit the CMS Electronic Prescribing Incentive ProgramExternal Website.

Additional Information

Two Vantage Way, Nashville, TN 37228 ©2014 CGS Administrators, LLC. All Rights Reserved