Electronic Prescribing (eRX) Incentive Program

Electronic Prescribing (eRx) Incentive Program: Before we discuss the eRx program and incentives, we will state that ZipChart EMR has a fully integrated e-prescribing application that allows EP's to qaulify for this incentive.

Background: The Electronic Prescribing (eRx) Incentive Program is a reporting program that uses a combination of incentive payments and payment adjustments to encourage electronic prescribing by eligible professionals. The program provides an incentive payment to practices with eligible professionals (identified on claims by their individual National Provider Identifier (NPI) and Tax Identification Number (TIN)) who successfully e-prescribe for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). Beginning in 2012, the program also applies a payment adjustment to those eligible professionals who are not successful electronic prescribers on their Medicare Part B services.

No Sign Up or Pre-Registration: There is no sign-up or pre-registration for individual eligible professionals to participate in the eRx Incentive Program. However, there are certain limitations on who can qualify for an eRx incentive payment. First, an eligible professional must have and use a qualified eRx system and report on his or her adoption and use of the eRx system. Second, the eligible professional must meet the criteria for a successful electronic prescriber specified by CMS for a particular reporting period. Finally, at least 10% of a successful electronic prescriber's Medicare Part B covered services must be made up of codes that appear in the denominator of the eRx measure

Note: The eRx Incentive Program requirements and measure specifications for the current program year may be different from the eRx Incentive Program requirements and measure specifications for a prior year. Eligible professionals are responsible for ensuring that they are using the eRx incentive documents for the correct program year. Information on the eRx measure can be found by clicking here.

2012 eRx Incentive: To qualify for a 2012 eRx incentive, individual eligible professionals may choose to report on their adoption and use of a qualified eRx system by submitting information on one eRx measure: (1) to CMS on their Medicare part B claims, (2) to a qualified registry, or (3) to CMS via a qualified electronic health record (EHR) product, or 4) to a qualified data submission vendor.

To be considered a successful electronic prescriber for the 2012 eRx Incentive Program and potentially qualify to earn a 1.0% incentive payment for the 2012 eRx Incentive Program, an individual eligible professional must report the eRx measure for at least 25 unique electronic prescribing events in which the measure is reportable by the eligible professionals during 2012.

A group practice may also potentially qualify to earn an eRx incentive payment equal to 1.0% of the group practice's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during the 2012 eRx reporting year based on the group practice meeting the criteria for successful electronic prescriber specified by CMS.

2012 eRx Payment Adjustment: Individual eligible professionals and group practices participating in the eRx Group Practice Reporting Option (GPRO) who are not successful electronic prescribers will be subject to a 1% payment adjustment on their Medicare Part B services provided January 1, 2012 through December 31, 2012.

To avoid the 2012 eRx payment adjustment, individual eligible professionals would have had to report the G8553 code via claims for at least 10 unique denominator eligible eRx events for services provided January 1, 2011 through June 30, 2011.

2013 eRx Payment Adjustment: Individual eligible professionals and group practices participating in the eRx Group Practice Reporting Option (GPRO) who are not successful electronic prescribers will be subject to a 1.5% payment adjustment on their Medicare Part B services provided January 1, 2013 through December 31, 2013.

To avoid the 2013 eRx payment adjustment, individual eligible professionals would have had to have been a successful electronic prescriber in 2011 or will need to report the G8553 code via claims for at least 10 billable Medicare Part B PFS services provided January 1, 2012 through June 30, 2012.