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The eRx Incentive Program Ended in 2013, but Electronic Prescribing Continues with Meaningful Use

2013 was the final program year for participating and reporting in the Medicare Electronic Prescribing (eRx) Incentive Program. The 6-month 2014 eRx payment adjustment reporting period, which began on January 1, 2013 and ended on June 30, 2013, was the final reporting period to avoid the 2014 eRx payment adjustment. You do not need to report G-codes (G8553) for 2014 eRx events.

• 2013 was the last year to earn an eRx incentive payment
• 2014 is the last year to incur an eRx payment adjustment

Content will remain available on this website so participants have an opportunity to access reference materials associated with the eRx incentive payment, payment adjustment, and feedback reports.

Note: electronic prescribing via certified EHR technology is still a requirement for eligible professionals in order to achieve meaningful use under the Medicare and Medicaid EHR Incentive Programs. Visit the EHR website for more information.

Step-by-Step Instruction for Getting Started with the Electronic Prescribing (eRx) Incentive Program

STEP 1:

Determine if you are eligible to participate for purposes of the eRx Incentive Program incentive payment and/or the payment adjustment. A list of professionals who are eligible and able to participate in the eRx Incentive Program is available by clicking on “Eligible Professionals” link on the left. Read this list carefully, as not all entities are considered eligible because they are reimbursed by Medicare under fee schedule methods other than the PFS.

STEP 2:

Review the list of eRx eligible denominator codes below. In order to earn an incentive payment or be subject to the payment adjustment, 10 percent of an eligible professional's Medicare Part B PFS charges must be comprised of the codes in the denominator of the measure.

eRx Measure Denominator Codes (Eligible Cases)

Patient visit during the reporting period (CPT or HCPCS):  90791, 90792, 90832, 90834, 90837, 90839, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109
CPT only copyright 2012 American Medical Association. All rights reserved.

STEP 3:

Adopt a qualified eRx system. Eligible professionals must have adopted a "qualified" eRx system in order to be able to report the eRx measure. There are two types of systems.

  1. a system for eRx only (stand-alone)
  2. an electronic health record (EHR system) with eRx functionality.

Regardless of the type of system used, to be considered “qualified” it must:

  1. Be Certified EHR Technology as defined at 42 CFR 495.4 and 45 CFR 170.102.  EHR technologies that meet these definitions are listed on the ONC website, http://onc-chpl.force.com/ehrcert

OR

  1. Be capable of ALL of the following functionalities:
    • Generating a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers (PBMs) if available.
    • Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all alerts.
    • Providing information related to lower cost, therapeutically appropriate alternatives, if any. The availability of an eRx system to receive tiered formulary information, if available, would meet this requirement for 2011.
    • Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient's drug plan, if available.

STEP 4:

Determine which eRx reporting method best suits your practice. If you have not yet participated in the eRx Incentive Program, you can begin by reporting eRx data for January 1-December 31, 2013 using any of the following three options for purposes of qualifying for the 2013 incentive:

  1. Claims-based reporting of the eRx measure. Report G-code (G8553) for 2013 eRx events.
  2. Registry-based reporting using a registry* to submit 2013 data to CMS during the first quarter of 2014.
  3. EHR-based reporting using a qualified* EHR product, submitting 2013 data to CMS during the first quarter of 2014.

*Only EHR vendors who have been vetted by CMS for the 2013 Physician Quality Reporting System/eRx Incentive Program and are on the posted list of EHR vendors are eligible to be considered “qualified” for purposes of reporting the 2013 eRx Incentive Program for purposes of the incentive payment. These EHR vendors are qualified to report eRx information to CMS. However, please note that their systems have not been checked for eRx functionality as defined in the specifications of the measure. A list of EHR Vendors for the 2013 eRx Incentive Program is available in the "Downloads" section of this page. A list of registries that self-nominated and are willing to submit data to CMS for the 2012 eRx Incentive Program is also available in the “Downloads” section of this page.

Once You Have Decided That You Want to Participate in the eRx Incentive Program for 2013, You Should Take the Following Steps to Report the Measure:

STEP 5: Did you bill one of the CPT or HCPCS G-codes noted above for the patient you are seeing?

NO: You do not need to report this measure for this patient for this visit.

YES: Proceed to Step 6.

STEP 6: You should report the following G-code (or numerator code) on the claim form that is submitted for the Medicare patient visit.

G8553 – At least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system.

  • We encourage you to report the G-code listed in Step 2 above on all of your patient visit claims along with one (or more) of the eligible denominator codes noted above. An example of reporting the eRx measure on the Form CMS-1500 (Health Insurance Claim Form) is available in the "Downloads" section of this page. Click on the link titled "2013 eRx Measure Specifications, Release Notes, and Claims-Based Reporting Principles for eRx Incentive Program”.

STEP 7: To be a successful individual electronic prescriber for purposes of eRx incentive payment eligibility, you must generate and report one or more electronic prescriptions associated with a patient visit for one (or more) of the eligible denominator codes noted above; a minimum of 25 unique visits per year. To avoid the 2014 eRx payment adjustment, you must be a successful electronic reporter in 2012 or report on a minimum of 10 unique visits via claims from January 1, 2013 through June 30, 2013. Each visit must be accompanied by the eRx G-code attesting that during the patient visit at least one prescription was electronically prescribed. Electronically generated refills do not count and faxes do not qualify as an electronic prescription. There is NO need to register to participate in this reporting program. Simply begin submitting the G-code on your claims appropriately, or report the information required by the measure to a registry, or submit the information required by the measure to CMS via a qualified EHR, if you satisfy the above requirements.

Other ways an eligible professional may avoid the 2014 payment adjustment are if the eligible professional:

  • Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of June 30, 2013, based on primary taxonomy code in the National Plan and Provider Enumeration System (NPPES);
  • Does not have prescribing privileges and reports G-code G8644 (defined as not having prescribing privileges) at least one time on an eligible claim prior to June 30, 2013;
  • Does not have at least 100 cases containing an encounter code in the measure denominator between January 1, 2013 and June 30, 2013
  • Does not meet the 10% denominator threshold between January 1, 2013 and June 30, 2013
  • Meets and reports a significant hardship exemption prior to June 30, 2013.
  • Achieves meaningful use during certain eRx Incentive Program timeframes, OR demonstrates intent to participate in the EHR Incentive Program and adopts Certified EHR Technology by registering for the EHR Incentive Program by January 31, 2013.

For more information on the eRx payment adjustment, click on the Payment Adjustment Information link located to the left of this page.