Medicare Electronic Prescribing Incentive Program

 
 

Overview
The Electronic Prescribing Incentive (eRx) Program, a CMS (Centers for Medicare and Medicaid Services) quality improvement program ended in 2013, but Electronic Prescribing  continues with Meaningful Use. 2014 is the last year to incur an eRx payment adjustment (penalty). CMS will keep content available on the website so participants have an opportunity to access reference materials associated with the eRx incentive payment, payment adjustment, and feedback reports.

NOTE: Electronic prescribing, which encourages electronic prescribing electronically to the pharmacy via certified EHR technology is still a requirement for eligible professionals (EP) in order to achieve Meaningful Use under the Medicare and Medicaid EHR Incentive Programs. Visit the CMS EHR Website for more information. 

Avoiding the 2014 eRx Penalty

The 2013 6-month reporting period (January 1- June 30, 2013) was the last reporting period to avoid the 2014 eRx payment adjustment/penalty of 2%. See the CMS document, 2013 Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment, for more detail.

These circumstances automatically exempted physicians from the 2014 eRx payment adjustment/penalty:

  • The physician was a successful electronic prescriber during the 2012 eRx 12-month reporting period (1/1/12–12/31/12)
  • The physician submitted at least 10 electronic prescriptions and reported the G-code (G8553) via claims during the 2013 eRx 6-month reporting period 1/1/13–6/30/13
  • The physician had fewer than 100 Medicare Part B PFS claims containing an encounter code in the measure’s denominator for dates of service from 1/1/13–6/30/13
  • The physician did not have 10% or more of their Medicare Part B PFS allowable charges (per TIN) for  encounter codes in the measure’s denominator for dates of service from 1/1/13–6/30/13
  • The eligible professional was not a physician as of June 30, 2013    
  • The physician did not have prescribing privileges and report G8644 on a payable Medicare Part B service at least once on a claim between 1/1/13–6/30/13
  • The physician achieved Meaningful Use under the Medicare or Medicaid EHR Incentive Program during the 12-month eRx reporting period (1/1/12–12/31/12) or the 6-month eRx reporting period (1/1/13-6/30/13) and attested during the 6-month reporting period (1/1/13–6/30/13)
  • The physician demonstrated intent to participate in the Medicare or Medicaid EHR Incentive Program by registering (providing EHR certification ID) during the 6-month reporting period (1/1/13-6/30/13) and adopting certified EHR technology    

There were six hardship exemptions to this penalty that were not automatic and may have required additional action.  CMS said eligibility for the exemptions would be considered on a case-by-case basis as it was for 2013. You must have applied for the 2014 exemption no later than June 30, 2013:

  • Inability to electronically prescribe due to state, or federal law, or local law or regulation    
  • The physician prescribed fewer than 100 prescriptions during a 6-month payment adjustment/penalty reporting period   
  • The physician practiced in a rural area without sufficient high-speed Internet access (reportable via claims as G8642)    
  • The physician practiced in an area without sufficient available pharmacies for electronic prescribing (reportable via claims as G8643)
  • Physicians and members within a group practice participating in eRx GPRO who achieved Meaningful Use under the Medicare or Medicaid EHR Incentive Program during the 12-month eRx reporting period (1/1/2012-12/31/2012) or the 6-month eRx reporting period (1/1/2013-6/30/2013) and attested during the 6-month reporting period (1/1/13-6/30/13). Determined by CMS through review of the EHR Incentive Program Attestation and Registration system and will be automatically processed by CMS
  • Physicians and members within a group practice participating in eRx GPRO who demonstrated intent to participate in the Medicare or Medicaid EHR Incentive Program during the 6-month reporting period (1/1/13-6/30/13). Determined by CMS through review of the EHR Incentive Program Attestation and Registration system and will be automatically processed by CMS

     In summary, if you did not apply and qualify for one of the exemptions, did not e-prescribe at least 10 times in the first six months of 2013, and did treat a significant number of Medicare patients under Part B, you could be hit with a 2% penalty on all of your Medicare claims for 2014.

Links pertaining to Electronic Prescribing Incentive Program


CMS Electronic Prescribing Incentive Program Website

CMS 2013 Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment    
                                                                                                                                           
APA Page on Electronic Prescribing

APA Practice Management Help Line
    800.343.4671 or hsf@psych.org