Practice and Advocacy
What you should know about the Medicare E-Prescribing Incentive Program
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Background The Electronic Prescribing (eRx) Incentive Program is a reporting program that uses a combination of incentive payments and payment adjustments (penalties) to encourage electronic prescribing by eligible professionals. The program provides an incentive payment to practices with eligible professionals (identified on claims by their National Provider Identifier [NPI] and Tax Identification Number [TIN]) who successfully e-prescribe for covered Medicare Physician Fee Service Schedule (MPFS) services for Medicare Part B Fee-for-Service (FFS) beneficiaries. Below is information on the following: Click on links below for related information I) Eligibility Criteria for Physicians and Group Practice II) Mechanisms for Reporting the eRx Measure V) Participating in the EHR, PQRS, and eRx Programs Simultaneously
E-Prescribing in 2013: What You Need to Do to Comply There are two reporting periods for eligible professionals (EPs) for 2013. EPs that successfully meet the criteria can avoid a percent payment reduction in 2014 and potentially earn a .5 percent bonus payment in 2014.
I) Eligibility Criteria for Physicians and Group Practice To be eligible to participate in the 2013 Medicare (eRx) Incentive Program, office visits should represent at least 10 percent of your total Medicare Part B Physician Fee Schedule charges from January 1, 2013 to June 30, 2013. You can only report the eRx measure for office visits that are separately listed on your Medicare claims and separately payable by Medicare. In order to be eligible to receive an eRx incentive payment in 2013, you must generate and report one or more electronic prescriptions associated with a minimum of 25 unique patient visits per year. Each visit must be accompanied by the electronic prescribing G-code (G8553 - At least one prescription created during the encounter was generated and transmitted electronically using a qualified ERX System) attesting that during the patient’s visit at least one prescription was electronically prescribed. The Centers for Medicare and Medicaid Services (CMS) requires that you use a "qualified" electronic prescribing system (stand-alone or an electronic health record system (EHR) with eRx functionality), which has all of the following capabilities:
The eRx measure (G8553) only qualifies for the incentive bonus when submitted with one of the following exam codes(CPT or HCPCS): 90791, 90792, 90832, 90834, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109. All groups participating in the 2013 eRx Group Practice Reporting Option (GPRO) need to notify CMS of their desire to do so as well as the reporting method they plan to use for each calendar year. If a group plans on participating in both the PQRS GPRO and eRx GPRO, this information maybe submitted via the web. If, however, they are part of an Accountable Care Organization (ACO) or wishes to participate solely in the eRx GRPO, they cannot self-nominate via the web and must submit an email. GPROs participating in the eRx GPRO for the 2013 incentive payment must report the eRx measure's numerator for at least 75 unique visits (groups 2-24 EPs), 625 unique visits (groups sized 25-00 EPs), or 2,500 unique visits (groups sized 100 or more EPs) by December 31st, 2013. II) Mechanisms for Reporting the eRx measure Individual EPs are not required pre-register to participate in the eRx program. As noted above, groups must register with CMS in the appropriate manner. To participate in the 2013 eRx Incentive program, you may choose to report on your adoption and use of a qualified eRx system by submitting information on one eRx measure, G8553 to:
III) Incentives and Penalties If you successfully e-prescribe medications and report the eRx measure in 2013 (by generating and reporting one or more electronic prescriptions associated with a minimum of 25 unique patient visits from January 1, 2013- December 31, 2013) you will earn incentives (in 2014) equal to .5 percent of your total Medicare payments for 2013. (You will obtain payment bonuses after the conclusion of the calendar year in which you e-prescribed for your Medicare patients, not as an immediate payment). This table shows the incentives and penalties in the eRx program through 2014:
Group Practice Reporting Option (GPRO): Groups are also eligible for incentive payments based on 2013 e-prescribing. Information on group reporting measures can be found here. Penalties for not participating in the eRx continue to increase every year of unsuccessful participation.To avoid a 2 percent penalty in 2014, an eligible physician needs to report the ePrescribing G-code, G8553, at least 10 times for Medicare office visits or services for the January 1, 2013 through June 30, 2013 reporting period on your Medicare Part B claim forms.All claims for services furnished between January 1, 2013, and June 30, 2013 needed to be received and processed by CMS no later than one month after the reporting period. Please note that electronically generated refills and faxes do not qualify as electronic prescriptions. Office visits provided as part of a global surgical package will not count towards the calculation of penalties for not adopting e-prescribing. The eRx penalty will not apply to you, if you do not:
IV) Hardship Exemptions Eligible Professionals may apply for a hardship exemption from CMS that would exempt them from penalties in 2014 based on 2013 claims. Physicians have to apply for the exemption from the 2014 penalty by June 30th, 2013. Visit the CMS web tool to apply. As a result of the advocacy of the Academy and several specialty societies, CMS, has continued to add new exemption categories to enable physicians to avoid the 2 percent Medicare E-Rx penalty in 2014 (based on 2013). The exemption groups are:
The eligible professional (EP) must be the person completing and submitting the hardship exemption form; office staff may not complete the form on the EPs behalf. For a GPRO, the hardship exemption must be provided by the GPRO member designated during the time of the self nomination process. For more information on the self-nomination process, please visit visit the GPRO website. CMS and the QualityNet Help Desk have been receiving calls from physicians who are having difficulty with accessing the Communication Support Page. CMS is asking physicians to take the step below if they are unsuccessful in accessing the Communication Support Page when trying to submit their Hardship Exemption Request:
If you are still having trouble accessing the site, the QualityNet Help Desk may be reached at 1-866-288-8912 or email at gnetsupport@sdps.org from 7 am to 7 pm CT, Monday through Friday. Due to the high volume of calls that the QualityNet Help Desk has been receiving, there may be a waiting period. V) Participating in the Medicare Electronic Health Records (EHR), Physician Quality Reporting System (PQRS) and eRx Programs Simultaneously You are not able to obtain incentives from both the Medicare eRx and the Medicare EHR incentive programs simultaneously. However, you may participate in the PQRS and eRx programs at the same time. Also, you may participate in the Medicaid EHR incentive program and still qualify for incentives under the eRx program. Information from the Academy on: If you have more questions on the eRx program, contact healthpolicy@entnet.org or visit the CMS Electronic Prescribing Incentive Payment website. |
