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Eligible Professionals

The Electronic Prescribing (eRx) Incentive Program is a voluntary health care reporting program that provides an incentive payment to identified eligible professionals or groups/organizations participating in eRx Incentive Program through the Group Practice Reporting Option (eRx GPRO) who satisfactorily report data on the eRx quality measure for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). The eRx Incentive Program also applies a payment adjustment from 2012 through 2014 to select eligible professionals if they do not become successful electronic prescribers.  

Eligible professionals do not need to participate in Physician Quality Reporting System (PQRS) to participate in the eRx Incentive Program as an individual. Starting in 2013, group practices who self nominate to participate in the eRx Incentive Program through eRx GPRO do not need to participate in PQRS.

Eligible and Able to Participate

Below is a list of 20 professionals who are eligible to participate in the eRx Incentive Program for the incentive payment. Eligible professionals must have prescribing authority in order to participate in this incentive program.  

Not all providers who are eligible to participate in the eRx Incentive Program for the incentive payment will be subject to eRx payment adjustments. The following professionals are eligible to participate in the eRx Incentive Program for the incentive payment. Only those professionals  marked with “subject to payment adjustment” are eligible to be subject to payment adjustments  if they are not successful at reporting the eRx Incentive Program measure:

1. Medicare physicians

• Doctor of Medicine (MD) – subject to payment adjustment
• Doctor of Osteopathic Medicine (DO) – subject to payment adjustment
• Doctor of Podiatric Medicine (DPM) – subject to payment adjustment
• Doctor of Optometry
• Doctor of Oral Surgery
• Doctor of Dental Medicine
• Doctor of Chiropractic

2. Practitioner

• Physician Assistant (PA) – subject to payment adjustment
• Nurse Practitioner* (NP) – subject to payment adjustment
• Clinical Nurse Specialist*
• Certified Registered Nurse Anesthetist* (and Anesthesiologist Assistant)
• Certified Nurse Midwife*
• Clinical Social Worker
• Clinical Psychologist
• Registered Dietician
• Nutrition Professional
• Audiologists

*Includes Advanced Practice Registered Nurse (APRN)

3. Therapists

• Physical Therapist
• Occupational Therapist
• Qualified Speech-Language Therapist

Eligible But Not Able to Participate

Some professionals may be eligible to participate per their specialty, but due to billing method may not be able to participate:

• Professionals who provide Part B services, but bill Medicare at a facility or institutional (Part A) level.
• Professionals who do not bill Medicare at an individual National Provider Identifier (NPI) level, where the rendering provider’s individual NPI is entered on CMS-1500 type paper or electronic claims billing, associated with specific line-item services.
• Professionals who reassign benefits to a Critical Access Hospital (CAH) that bills outpatient services at a facility level, such as CAH Method II billing, cannot participate, since the CAH does not include the individual provider NPI on their Institutional (FI) claims.

Services payable under fee schedules or methodologies other than the PFS are not included in the eRx Incentive Program (for example, services provided in federally qualified health centers, independent diagnostic testing facilities, independent laboratories, hospitals [including method I critical access hospitals], rural health clinics, ambulance providers, and ambulatory surgery center facilities).

Eligible professionals participating in the eRx Incentive Program and their office staff should familiarize themselves with the eRx Incentive Program requirements for the relevant program year.  

Please note that 2013 is the last year to report for the eRx Incentive Program. The Medicare Improvements for Patients and Providers Act of 2008 (known as MIPPA) authorized eRx incentive payments through 2013. Payment adjustments will be applied through 2014 based on the previous year’s reporting.