2011 eRX Incentive Program

Where to begin?

You DO NOT need to register to participate in this incentive program. Begin by submitting the G-code on your claims according to the guidelines below or submit the information required by the measure to CMS via MediSYS EHR, an ONC-Certified EHR system.

2011 ePrescribe Incentive for eligible professionals includes:

• 1% Incentive Payment (not applicable to professional receiving 2011 incentive from Medicare EHR Incentive Program*.)
• Must use a qualified eRX system
• Report the 2011 eRX measure of G8553 with a qualified procedure code G8553: At least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system
• Report this G8553 for at least 25 unique eRX events with the applicable denominator during the reporting period
• At least 10% of the eligible professional’s charges based on codes:-Denominator – 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 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

Updated *Important Note: Providers who elect to participate in the Medicare or Medicaid EHR Incentive Program do not qualify for ePrescribe incentives but must now report the ePrescribe exemption code by 11/1/11 via CMS web-portal to avoid an eRX payment adjustment in 2012.

In addition, it is important to note that CMS will determine which EPs are subject to a payment penalty in 2012 based on claims data from Jan. 1, 2011 – June 30, 2011. CMS will analyze the claims during the first six months of 2011 to determine if the EP has submitted at least 10 electronic prescriptions with the G-code 8553. If not a 1% payment adjustment will occur with regard to the EPs Part B-covered professional services.

CMS added four additional hardship exemption codes on August 31, 2011.  The e-prescribing penalty exemption categories that must be submitted for individual providers via web-portal by 11/1/11 include:

• The practice is located in a rural area without high speed internet access.
• The practice is located in an area without sufficient available pharmacies for electronic prescribing.
• Registration to participate in the Medicare or Medicaid EHR Incentive Program and adoption of Certified EHR Technology.
• Inability to electronically prescribe due to local, State or Federal law or regulation.
• Limited prescribing activity.
• Insufficient opportunities to report the e-prescribing measure due to limitations of the measure’s denominator.

Original G-codes for hardship / exemptions:

• G8642 – The eligible professional practices in a rural area without sufficient high speed internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.

• G8643 – The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.

Exemption Code: Another reporting option: When the eligible professional does not have prescribing privileges, report G8644 via claims. If this code is utilized, the eligible professional may not be considered for a payment adjustment.

Please refer often to http://www.cms.gov/ERxIncentive/ for more information regarding ePrescribing incentives.

Medicare’s Guide to ePrescribing