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Group Practice Reporting Option

In accordance with section 1848(m)(3)(C) of the Social Security Act (the Act), CMS is introducing a new group practice reporting option (GPRO) for the Electronic Prescribing (eRx) Incentive Program beginning with the 2010 eRx Incentive Program. Group practices that are successful electronic prescribers for a particular reporting period are eligible to earn an eRx incentive payment equal to a specified percentage of the group practice's total estimated Medicare Part B PFS allowed charges for covered professional services furnished during the reporting period. For the 2010 eRx Incentive Program, the incentive payment is equal to 2% of the group practice's total estimated Medicare Part B PFS allowed charges for covered professional services furnished during the 2010 reporting period. As required by section 1848(m)(3)(C)(iii) of the Act, an individual eligible professional who is a member of a group practice selected to participate in the eRx GPRO is not eligible to separately earn an eRx incentive payment as an individual eligible professional under that same Tax Identification Number (TIN) (that is, for the same TIN/National Provider Identifier, or NPI, combination). Once a group practice (TIN) is selected to participate in the GPRO, this is the only method of eRx reporting available to the group and all individual NPIs who bill Medicare under the group's TIN.

2013 eRx Incentive Program GPRO: Participation for the Incentive Payment Made Simple

CMS has posted the 2013 eRx Incentive Program GPRO: Participation for the Incentive Payment Made Simple for group practices wishing to participate in the 2013 eRx Incentive program for incentive purposes through GPRO. To view click on the file entitled "2013 eRx Incentive Program GPRO: Participation for the Incentive Payment Made Simple" in the "Downloads" section below.  

2013 eRx GPRO  Requirements

CMS has posted the Group Practice Reporting Option (GPRO) requirements for submission of 2013 eRx Data.  To view click on the file entitled "2013 eRx GPRO Requirements" in the "Downloads" section below.  

2013 eRx GPRO Measures Specifications

The eRx GPRO measure specification has been updated for the 2013 eRx Program year. The measure may be reported through various reporting options. The file is named "2013 eRx GPRO Measure Specifications, Release Notes and Claims Based Reporting Principles". The zip file contains three helpful documents:

1. 2013_eRx_GPROMeasureSpecification_110912.pdf – Contains the eRx Measure Specification for the 2013 program year.

2. 2013_eRx_GPROMeasuresSpecification_ReleaseNotes_110912.pdf – Details the changes made to the eRx Measure Specification since the 2012 program year.

3. 2013_eRx_ClaimsBasedReportingPrinciples_110912.pdf – Explains how to report the eRx measure for the 2013 eRx program year.

2012 eRx  GPRO

The eRx CMS-selected GPRO Measure has been updated for the 2012 eRx Program year. The measure may be reported through various reporting options. The file is named "2012 CMS-Selected GPRO eRx Measure Specifications, Release Notes and Claims Based Reporting Principles". The zip file contains three helpful documents:

  1. 2012_eRx_GPROMeasureSpecification_111011.pdf – Contains the eRx Measure Specification for the 2012 Program Year.
  2. 2012_eRx_GPROMeasuresSpecification_ReleaseNotes_111011.pdf – Details the changes made to the eRx Measure Specification since the 2011 Program Year.
  3. 2012_eRx_ClaimsBasedReportingPrinciples_111011.pdf – Explains how to report the eRx measure for the 2012 eRx Program Year.

2012 eRx GPRO Training Materials

CMS-selected group practices that are participating in the 2012 eRx GPRO are required to take part in mandatory training.  The slide presentations used as training documents for these CMS-selected group practices and supporting documents will be posted in the “Downloads” section below.   These documents can be found in the zip file titled “2012 eRx GPRO Training Materials”.

2011 eRx GPRO

GPRO Requirements for Submission of 2011 eRx Data. While participation in the eRx Incentive Program (either as an individual eligible professional or under the eRx GPRO) is voluntary for group practices participating in the Physician Quality Reporting System GPRO, CMS requires that in order for a group practice to participate in the 2011 eRx GPRO, a group practice must comply with all requirements for participation in the Physician Quality Reporting System GPRO and be participating in the Physician Quality Reporting System GPRO for 2011. A group practice that wishes to participate in both the Physician Quality Reporting System GPRO and in the eRx GPRO, must notify CMS of its desire to do so when self-nominating for the 2011 Physician Quality Reporting System GPRO. The Physician Quality Reporting System GPRO requirements and instructions for submitting the self-nomination letter can be found in the "Downloads" section below. Additional information on the Physician Quality Reporting System GPRO can also be found by clicking on the "Physician Quality Reporting System GPRO" link under the "Related Links Inside CMS" section below.

The eRx Measure has been updated for the 2011 eRx Program year. The measure may be reported through various reporting options. Instructions for submitting the eRx Measure including ways to avoid the 2012 eRx Payment Adjustment can be found in the following documents, available in the "Downloads" section below.  The file is named "2011 GPRO I eRx Claims Based Reporting Principles, Measure Specifications and Release Notes". The zip file contains three helpful documents:

  1. 2011_eRx_ClaimsBasedReportingPrinciples_111510.pdf – Explains how to report the eRx measure or hardship codes for the 2011 eRx Program Year.
  2. 2011_GPROI_eRxMeasureSpecifications_07062011.pdf – Contains the eRx Measure Specification for the 2011 Program Year.
  3. 2011_eRx_Measure_Specification_GPROI_ReleaseNotes_070611.pdf – Details the changes made to the eRx Measure Specification since the 2011 Program Year.

2010 eRx GPRO

GPRO Requirements for Submission of 2010 eRx Data. While participation in the eRx Incentive Program (either as an individual eligible professional or under the eRx GPRO) is voluntary for group practices participating in the Physician Quality Reporting System GPRO, CMS requires that in order for a group practice to participate in the 2010 eRx GPRO, a group practice must comply with all requirements for participation in the Physician Quality Reporting System GPRO and be participating in the Physician Quality Reporting System GPRO for 2010. A group practice that wishes to participate in both the Physician Quality Reporting System GPRO and in the eRx GPRO, must notify CMS of its desire to do so when self-nominating for the 2010 Physician Quality Reporting System GPRO. The Physician Quality Reporting System GPRO requirements and instructions for submitting the self-nomination letter can be found in the “Downloads” section below. Additional information on the Physician Quality Reporting System GPRO can also be found by clicking on the “Physician Quality Reporting System GPRO” link under the “Related Links Inside CMS” section below.

2010 Criteria for Determining Whether a Group Practice is a Successful Electronic Prescriber Under the 2010 eRx GPRO. For purposes of determining whether a group practice is a successful electronic prescriber for 2010, each group practice selected to participate in the 2010 eRx GPRO will be required to report the eRx measure either through claims, a qualified registry, or a qualified EHR product. A list of qualified registries and EHR products for the 2010 eRx Incentive Program will be made available in the “Alternative Reporting Mechanisms” link at left.

The specifications for the eRx measure for use in the 2010 eRx GPRO can be found in the “Downloads” section below. For purposes of the 2010 eRx Incentive Program, a successful group practice electronic prescriber, must report the eRx measure for a minimum of 2,500 unique denominator-eligible visits per year. Attempts to report the measure for visits not associated with a denominator eligible patient visit do not count towards the minimum of 2,500.

In addition to meeting the criteria for “successful electronic prescriber” above, at least 10% of the group practice's Medicare Part B charges must be comprised of the codes in the denominator of the measure in order for the group practice to be incentive eligible.