Sign In
  • Birmingham 205.631.5969
  • Montgomery 334.277.6201

2013 eRx Incentive Program: 2014 eRX Payment Adjustment

Quick Facts

  • 2013 eRX incentive payment reporting period: January 1, 2013 – December 31, 2013
  • You DO NOT need to register to participate.
  • 0.5% Incentive:  based on 2013 activity and paid in 2014
  • 2.0% Payment Reduction:  based on 2013 activity, levied in 2014

Am I eligible?

 

Reporting

  • Reporting:
    • Step 1: Bill one of the CPT or HCPCS codes noted in the denominator of the eRx measure for eligible patient visits. (see “Eligible Encounter Codes” table below)
    • Step 2: Submit G8553 on applicable Medicare claims
  • G8553 definition – At least one prescription created during the encounter was generated and transmitted electronically using a qualified  eRX system.
  • Or, submit applicable hardship codes (between January  1, 2013 – June 30, 2013) on the Quality Reporting Communications Support Page. Exemptions DO NOT carry over from year to year, you will need to apply each year for a hardship exemption.
  • Report per Tax ID Number (TIN)
  • Reporting Periods:
    • January 1, 2013 to June 30, 2013 to Avoid Penalty of 2.0% and/or submit hardship
    • January 1, 2013 to December 31, 2013 for potential 0.5% incentive

 

Dates of Service and/or REPORTING PERIODS

G8553 MINIMUM THRESHOLD

INCENTIVE/PENALTY AMOUNTS

YEAR LEVIED

1/1/2013 – 06/30/2013

10

TO AVOID 2% PENALTY (or submit hardship, if applicable)

2014

1/1/2013 – 12/31/2013

25

(or 75 for 2+ groups)

POTENTIAL 0.5% INCENTIVE

2014

 

Guidelines

  • 2013 eRx Incentive:
    • eRx refills that are not associated with a face-to-face encounter do NOT qualify
    • Faxed prescriptions do NOT qualify
    • eRx not associated with a code in the denominator of the eRx measure specification do NOT qualify
    • If a claim is denied/rejected, then the eRX G-code will NOT be included in the eRX Incentive Program analysis.
Encounter Codes  REMOVED for 2013 Encounter Codes ADDED for 2013 COMPLETE LIST for 2013:Eligible Encounter Codes (CPT or HCPCS codes)
9080190802

90804

90805

90806

90807

90808

90809

90862

9079190792

90832

90834

90837

90839

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

 

  • 2014 eRX Payment Adjustment (based on 2012 and 2013 participation):
    • Eprescribe at least 10 G8553 codes on any paid Medicare claims by June 30th, 2013 to avoid the 2% eRX payment adjustment that will be levied in 2014.
    • Report G8553 on any billable, covered Medicare Part B service/visit claims  as long as you treated and ePrescribed for a Medicare patient.
    • If you reported the G8553 code at least 25 times in 2012 (received the 2012 incentive) then you are automatically exempt from the 2014 eRX payment adjustment.
    • If you were a successful Meaningful Use in 2012 (either 90 days or first year) then you are automatically exempt from the 2014 eRX payment adjustment.
    • If you start Meaningful Use in 2013 and successfully finish your 90 days before June 30th, then you are automatically exempt from the 2014 eRX payment adjustment.
    • If you registered (for Meaningful Use) before 1/1/13 and you have NOT completed 90 days by June 30th then you are NOT exempt from the eRX Payment Adjustment. If you registered before 1/1/13, there are 2 ways to avoid the eRX payment adjust:
      • Eprescribe 10 G8553 codes on any paid Medicare claims by June 30th, 2013
      • Begin Meaningful Use in 2013 and complete your 90 days before June 30th, 2013
    • For more information regarding the eRX Payment Adjustment please visit: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive/20_Payment_Adjustment_Information.html

 

For more information on the CMS eRx Incentive Program Measure Specification and/or the Payment Adjustment please visit the CMS website at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive.

 

Need Assistance?

QualityNet Help Desk

7:00 AM – 7:00 PM CT

Phone: 1-866-288-8912

TTY: 1-877-715-6222

Email: qnetsupport@sdps.org