2012 eRX Incentive Program

• Eligible Professionals
• 1% Incentive
• 1% Penalty (based on 2011 activity)
• Incentive not applicable if participating in Medicare EHR Incentive Program
• In order to be incentive eligible as a successful electronic prescriber for the 2012 eRx Incentive Program, an eligible professional must generate at least one eRx associated with a patient visit on 25 or more claims during the reporting period (January 1 through December 31, 2012).
• Patient visit is one with applicable denominators during the reporting period (CPT or HCPCS):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
• Report on Claims G-Code, G8553 during this reporting period (January 1 through December 31, 2012)
• Note: in order to AVOID an eRX Penalty in 2013, EP must report the G8553 at least 10 times on claims as applicable by June 30, 2012. The penalty jumps to 1.5% for 2013.
  

For more information please visit:  http://www.cms.gov/ERxIncentive

IMPORTANT Notice: 2012 eRx Penalty

Due to high volume of hardship exemption requests, it is not feasible for CMS to provide 2012 eRX Payment Adjustment (penalty) feedback reports.  CMS is strongly encouraging all eligible providers to carefully review their 2012 remittance advice for all services rendered in 2012.  If a 1% payment adjustment is being taken in error, notify CMS immediately so they may reprocess the claims.

Also note, the 2012 eRx penalty will be applied separately from the 2011 Incentive program payment or any other CMS incentive program payments.

Look for “LE” on the remittance advise which indicates an eRX payment adjustment and the Claim Adjustment Reason Codes:

• CARC 237 – Legislated/Regulatory Penalty
• RARC N545 – Payment reduced based on status as an unsuccessful e-prescriber per eRX incentive program.

For more information visit, http://www.cms.gov/erxincentive  MLN Matters Article SE1141 and  CMS Quick Guide Understanding eRX Payment Adjustment

For more information about Future Payment Adjustmetns: https://www.cms.gov/ERxIncentive/downloads/2012eRx_FuturePaymentAdjustments_01-30-2012_508_2.pdf

How to Avoid an eRX Penalty in 2013 (1.5% penalty)

To AVOID an eRX Penalty in 2013, EP must report the G8553 at least 10 times on claims for any billable Medicare service as applicable provided by June 30, 2012.