Electronic Prescribing (eRx) Incentive Program
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"What's New" (recently posted items) for the eRx Incentive Program
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. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for the eRx Incentive Program.
The eRx Incentive Program is mandated by federal legislation. CMS implements the eRx Incentive Program through regulations published in the Federal Register. Information regarding the relevant statutes and regulations can be found by clicking on the "Statutes Regulations Program Instructions" link to the left.
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. A list of professionals eligible to participate in the eRx Incentive Program is available by clicking on the "Eligible Professionals" link at left.
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 on the "eRx Measure" section page to the left.
2014 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 2.0% payment adjustment on their Medicare Part B services provided January 1, 2014 through December 31, 2014.
To avoid the 2014 eRx payment adjustment, individual eligible professionals would have had to have been a successful electronic prescriber in 2012 or will need to report the G8553 code via claims for at least 10 billable Medicare Part B PFS services provided January 1, 2013 through June 30, 2013. Please review the factsheet titled "2013 eRx Incentive Program: 2014 Payment Adjustments" on the "Payment Adjustment Information" section page to the left for more detailed information, including how an eligible professional or group practice can quality and request a hardship exemption to the 2014 eRx payment adjustment.
2013 eRx Incentive
To have qualified for a 2013 eRx incentive, individual eligible professionals would have had to 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 learn more about how to participate in the eRx Incentive Program, visit the “How To Get Started” link as well as the “Educational Resources link at left. Fact sheets are available on to help you understand the reporting requirements. Information for the registry-based, EHR-based, or data submission vendor-based reporting mechanism for the eRx Incentive Program can be found at the respective “Registry Reporting” and “Electronic Health Record Reporting” links to the left.
To have been considered a successful electronic prescriber for the 2013 eRx Incentive Program and potentially qualify to earn a 0.5% incentive payment for the 2013 eRx Incentive Program, an individual eligible professional would have had to report the eRx measure for at least 25 unique electronic prescribing events in which the measure is reportable by the eligible professionals during 2013.
A group practice may also potentially qualify to earn an eRx incentive payment equal to 0.5% of the group practice's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during the 2013 eRx reporting year based on the group practice meeting the criteria for successful electronic prescriber specified by CMS. Click on the "Group Practice Reporting Option" link at left to learn more about this reporting option and to obtain instructions on how a group practice can sign up to participate in this reporting option.
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, reported the G8553 code via claims for at least 10 billable Medicare Part B PFS services provided January 1, 2012 through June 30, 2012 or approved for a significant hardship exemption.
To find out who to contact with questions regarding the eRx Incentive Program, click on the "Help Desk Support" link at left.
- Page last Modified: 07/17/2013 12:36 PM
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