Finding E-prescribing Facts Just Got Easier

The Centers for Medicare & Medicaid Services (CMS) has added two new fact sheets to the Educational Resources portion of its website to help providers who are interested in participating in the Electronic Prescribing (eRx) Incentive Program.

The first fact sheet, entitled “2011 Electronic Prescribing (eRx) Incentive Program Made Simple” reminds providers that there is no need to register to participate in the eRx Incentive Program, and in just three, easy-to-follow pages:

  • lists all available reporting options to participate in eRx
  • provides three simple questions that providers should ask themselves before reporting an eRx measure
  • defines a qualified eRx system
  • lists eligible CPT® and HCPCS Level II denominator codes
  • outlines four steps that a provider must take to submit claims under the eRx program

The second fact sheet, “2011 Electronic Prescribing (eRx) Incentive Program Made Simple Reference Chart,” concentrates on the three questions (mentioned above) that providers should ask themselves before reporting an eRx measure, as follows:

QUESTION 1: Do I have an eRx system/program and am I routinely using it?

QUESTION 2: Is my system capable of performing the functions of a qualified system?

QUESTION 3: Do I expect my Medicare Part B Physician Fee Schedule (PFS) charges for the patient visit codes (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) in the denominator of the measure to make up at least 10 percent of my total Medicare Part B PFS allowed charges for 2011?

If the answer to all three questions is YES, you may be eligible for the incentive payment equal to 1 percent of your Medicare Part B PFS allowed charges for services furnished during the reporting period, and you should report the eRx measure.

If the answer to the first two questions is YES but the answer to the third question is NO, you may not be eligible for the incentive payment; however, you are encouraged to report the measure. In the event that your Medicare Part B PFS charges for the codes in the denominator of the measure do make up at least 10 percent of your total Medicare Part B PFS allowed charges for 2011, you may be eligible for the incentive payment.

If the answer to either of the first two questions is NO, you cannot report this measure unless you obtain and use a qualified eRx system.

The eRx incentive for reporting years 2012-2012 is 1 percent. Eligible professionals may begin reporting the eRx measure at any time throughout the 2011 program year (Jan. 1-Dec. 31) to be incentive eligible, and can still qualify to receive a full-year incentive payment for 2011 (note that you cannot earn an eRx incentive payment and a Medicare EHR/meaningful use incentive payment for the same program year). You must, however, have begun participation prior to June 30, 2011 to be exempt from the 2012 eRx (negative) payment adjustment. For 2012, eligible professionals receiving a payment adjustment will be paid 1 percent less than the Medicare Physician Fee Schedule (MPFS) amount for that service. In 2013 and 2014, the payment adjustment increases to 1.5 percent and 2 percent, respectively.

For additional information on the eRx program, visit the CMS website.

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