Medicare Electronic Prescribing (eRx) Incentive Program
The Centers for Medicare & Medicaid Services (CMS) Electronic Prescribing, or e-prescribing, 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.” Originally a quality measure in the 2008 Physician Quality Reporting Initiative (PQRI), CMS removed the e-prescribing measure and implemented a separate pay-for-reporting incentive program in 2009, with the goal of advancing quality through safer, more coordinated prescription writing. The creation of this pay-for-reporting program allows eligible professionals to potentially be able to qualify for two incentive payments in 2012 – one for e-prescribing and one for the Physician Quality Reporting System (PQRS). Eligible professionals who successfully e-prescribed in 2012 qualify for an incentive payment of 1.0 percent. Table one on this page shows both the incentive and penalties for each year after 2012.
Table 1 |
Changes to the Electronic Prescribing (eRx) Incentive Program (Final Rule)
eRx, What you need know
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 for the eligible denominator codes).
Table 2 |
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 here. Refer to Table 3 for the hardship exemptions available for 2013. In addition, visit HERE FOR the 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, 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 December 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 |
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)
Introduction to eRx:
eRx Bulletin Article Coming SoonCMS 2012 eRx Made Simple
Reporting
Step-by Step Guide on How to Apply for the 2013 Hardship Exemption—Deadline June 30th, 2012
CMS Guidance Document on Using the Communications Support Page
Regulatory
2012 Medicare Physician Fee Schedule Final Rule
2011 Medicare eRx Incentive Program Final Rule
Revised May 8, 2012