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:
- Generating a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers, if available
- Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all alerts
- Providing information related to lower cost, therapeutically appropriate alternatives (if any). The availability of an eRx system to receive tiered formulary information, if available
- Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient's drug plan, if available
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.