Medicare Electronic Prescribing Incentive Program

 
 

Overview
The Electronic Prescribing Incentive (eRx) Program, a CMS (Centers for Medicare and Medicaid Services) quality improvement program continuing in 2013, encourages electronic prescribing (transmitting a prescription electronically directly to a pharmacy) by eligible professionals. The eRx program offers incentives to clinicians who use a qualified e-prescribing system as well as penalties for those not reporting use of a system.  Participation in the program involves the reporting of designated administrative codes on billing claims. Clinicians who meet the requirements for being a successful e-prescriber (i.e., submit 25 eRx events by December 31, 2013) will be eligible for an additional 0.5% bonus for CY 2013 and will be listed on the public Physician Compare Website.  Those who do not demonstrate use of electronic prescribing at least 10 times in the first 6 months of 2013 may be subject to a 2% payment reduction/penalty in 2014. See below for information on action that might need to be taken by June 30, 2013 to avoid the 2014 penalty.

Earning the 2013 eRx Incentive
A psychiatrist using a qualified electronic prescribing system is eligible for the full 2013 bonus (0.5% of all Medicare Part B charges) if s/he reports electronic prescriptions associated with at least 25 unique patient visits during the 2013 incentive reporting period (January 1 - December 31, 2013).  An administrative code, G8553, is reported on the claim for an encounter where at least one prescription was generated and transmitted electronically. Claims must be processed by February 28, 2014 to receive the 2013 incentive payment.  The CMS eRx Incentive website describes in detail how to participate in the program.  E-prescribing can be accomplished either with freestanding software or it can be done using part of an electronic health records (EHR) system.  A physician cannot participate in both the Electronic Prescribing Program and the Electronic Health Record (EHR) Incentive Program.  The AMA eRx Learning Center is a good resource for finding an eRx system. 

Avoiding the 2014 eRx Penalty
The 2013 6-month reporting period (January 1- June 30, 2013) is the last reporting period to avoid the 2014 eRx payment adjustment/penalty of 2% in 2014.  See the CMS document, 2013 Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment, for more detail.

These circumstances automatically exempt you from the 2014 eRx payment adjustment/penalty:

  • The physician was a successful electronic prescriber during the 2012 eRx 12-month reporting period (1/1/12–12/31/12)
  • The physician submits at least 10 electronic prescriptions and reports the G-code (G8553) via claims during the 2013 eRx 6-month reporting period 1/1/13–6/30/13
  • The physician has fewer than 100 Medicare Part B PFS claims containing an encounter code in the measure’s denominator for dates of service from 1/1/13–6/30/13
  • The physician does not have 10% or more of their Medicare Part B PFS allowable charges (per TIN) for  encounter codes in the measure’s denominator for dates of service from 1/1/13–6/30/13
  • The eligible professional is not a physician as of June 30, 2013    
  • The physician does not have prescribing privileges and reports G8644 on a payable Medicare Part B service at least once on a claim between 1/1/13–6/30/13
  • The physician achieves Meaningful Use under the Medicare or Medicaid EHR Incentive Program during the 12-month eRx reporting period (1/1/12–12/31/12) or the 6-month eRx reporting period (1/1/13-6/30/13) and attests during the 6-month reporting period (1/1/13–6/30/13)
  • The physician demonstrates intent to participate in the Medicare or Medicaid EHR Incentive Program by registering (providing EHR certification ID) during the 6-month reporting period (1/1/13-6/30/13) and adopting certified EHR technology    

Note: Medicare has suggested that participants submit more than the minimum number of events, in case any of the submissions are not accepted.
 
There are six hardship exemptions to this penalty that are not automatic and may require additional action.  CMS has said eligibility for the exemptions will be considered on a case-by-case basis as it was for 2013. You must apply for the 2014 exemption no later than June 30, 2013:

  • Inability to electronically prescribe due to state, or federal law, or local law or regulation    
  • The physician prescribes fewer than 100 prescriptions during a 6-month payment adjustment/penalty reporting period   
  • The physician practices in a rural area without sufficient high-speed Internet access (reportable via claims as G8642)    
  • The physician practices in an area without sufficient available pharmacies for electronic prescribing (reportable via claims as G8643)
  • Physicians and members within a group practice participating in eRx GPRO who achieve Meaningful Use under the Medicare or Medicaid EHR Incentive Program during the 12-month eRx reporting period (1/1/2012-12/31/2012) or the 6-month eRx reporting period (1/1/2013-6/30/2013) and attest during the 6-month reporting period (1/1/13-6/30/13). Determined by CMS through review of the EHR Incentive Program Attestation and Registration system and will be automatically processed by CMS
  • Physicians and members within a group practice participating in eRx GPRO who demonstrate intent to participate in the Medicare or Medicaid EHR Incentive Program during the 6-month reporting period (1/1/13-6/30/13). Determined by CMS through review of the EHR Incentive Program Attestation and Registration system and will be automatically processed by CMS

Eligible professionals do not need to apply for the last 2 EHR-related hardship exemptions through the Quality Reporting Communication Support web page (Communication Support Page) if they registered or attested for the EHR Incentive Program by January 31, 2013.      
       
In summary, if you don’t apply and qualify for one of the exemptions, don’t e-prescribe at least 10 times in the first six months of 2013, and did treat a significant number of Medicare patients under Part B, you could be hit with a 2% penalty on all of your Medicare claims for 2014.

Links pertaining to Electronic Prescribing Incentive Program
CMS Electronic Prescribing Incentive Program Website

CMS 2013 Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment    
                                                                                                                                           
CMS Electronic Prescribing Educational Video

CMS QualityNet Help Desk
    (CMS Contact for questions regarding the eRx Incentive Program)
     866-288-8912 (Monday through Friday from 7am-7pm CT)
    or via qnetsupport@sdps.org

AMA Page on the Electronic Prescribing Incentive Program
   
AOA Page on the Electronic Prescribing Incentive Program

APA Page on Electronic Prescribing

APA Practice Management Help Line
    800.343.4671 or hsf@psych.org