CMS issues exemptions for eRx incentive program

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The Centers for Medicare & Medicaid Services (CMS) has released information about its 2013  Payment Adjustment Hardship Exemption for the Electronic Prescribing (eRx) Incentive Program, which was implemented in 2009. The program uses incentive payments and payment adjustments to encourage the use of qualified electronic prescribing systems.

From 2012 through 2014, a payment adjustment that increases each calendar year will be applied to an eligible professional’s Medicare Part B Physician Fee Schedule (PFS) covered professional services for not becoming a successful electronic prescriber.

The payment adjustment of 1 percent in 2012, 1.5 percent in 2013 and 2 percent in 2014 will result in an eligible professional or group practice participating in the eRx Group Practice Reporting Option (eRx GPRO) receiving 99 percent, 98.5 percent and 98 percent respectively of their Medicare Part B PFS amount for covered professional services. 

The 2013 eRx payment adjustment only applies to certain individual eligible professionals. CMS will automatically exclude those individual eligible professionals who meet the following criteria:

  • The eligible professional is a successful electronic prescriber during the 2011 eRx 12-month reporting period (Jan.1, 2011 through Dec. 31, 2011).
  • The eligible professional is not an MD, DO, podiatrist, nurse practitioner or physician assistant by June 30, 2012, based on primary taxonomy code in the National Plan and Provider Enumeration System.
  • The eligible professional does not have at least 100 Medicare Physician Fee Schedule (MPFS) cases containing an encounter code in the measure’s denominator for dates of service from Jan. 1, through June 30. 
  • The eligible professional does not have 10 percent or more of their MPFS allowable charges (per TIN) for encounter codes in the measure’s denominator for dates of service from Jan. 1 through June 30. 
  • The eligible professional does not have prescribing privileges and reported G8644 on a billable Medicare Part B service at least once on a claim between Jan. 1 and June 30.

Individual eligible professionals and CMS-selected group practices participating in eRx GPRO who were not successful electronic prescribers in 2011 can avoid the 2013 eRx payment adjustment by meeting the following specified reporting requirements between Jan. 1 and June 30:

  • Individual Eligible Professionals – 10 eRx events via claims
  • Small eRx GPRO – 625 eRx events via claims
  • Large eRx GPRO – 2,500 eRx events via claims

For more information on individual and eRx GPRO reporting requirements, see the MLN Article SE1206 - 2012 eRx Incentive Program: Future Payment Adjustments.