February 14, 2014
ePrescribing (eRx) in 2014: Facts to Know
2013 was the final year for eligible professionals (EPs) to earn an ePrescribing (eRx) incentive. 2014 is the final year that eRx payment adjustments will be applied.
What this means for you:
- Submitting claims: for services provided in 2014, do not report HCPCS code G8553. This code signifies that "at least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system" and was used to track successful reporting for the eRx incentive.
- Payment adjustments for 2014 services:
- If you did not meet requirements to be a "successful e-Prescriber" based on information submitted on your claims (for individual EPs) or through the Group Practice Reporting Option (GPRO) (for group practices), claims for dates of service in 2014 for services that are payable under the Medicare Physician Fee Schedule (MPFS) will be subject to a 2% payment adjustment (that is, 98% of the MPFS amount). The following tables in this article describe exceptions to the 2% payment adjustment.
- If CMS subsequently determines a payment adjustment was applied in error, the claim will be automatically reprocessed to return the 2.0% adjustment, and the Remittance Advice for the reprocessed claim will indicate that the payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program. You don't need to request a reopening or take any action in these cases because claims will be reprocessed automatically. Please allow a couple months for claims to be re-processed and adjustments to be corrected. (Source: CMS fact sheet "2013 Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment
") You will be able to identify any adjustments with Claims Adjustment Remark Code 237 and Remittance Adjustment Remark Code N546. - EPs or group practices who participated in eRx GPRO can request an informal review if they were notified of being subject to the 2014 eRx payment adjustment. Informal review requests can be submitted to eRxInformalReview@cms.hhs.gov through February 28, 2014. Read more about the informal review process in this CMS fact sheet.
- If you (as an individual EP) or your group is not subject to the eRx payment adjustment, and your payments are being reduced, contact the QualityNet Help Desk at 866.288.8912 or qnetsupport@sdps.org. Hours are Monday-Friday, 7 a.m. – 7 p.m. CT.
Individual EPs
The following table, which was extracted from the CMS fact sheet "2013 Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment," lists payment adjustment exclusion criteria for individual EPs. If any one of the following criteria applies, the negative eRx payment adjustment will not be applied in 2014.
| 2014 eRx Payment Exclusion Criteria: Individual EPs |
|---|
The eligible professional is a successful electronic prescriber during the 2012 eRx 12-month reporting period (1/1/12-12/31/12) The eligible professional is not an MD, DO, podiatrist, Nurse Practitioner, or Physician Assistant by 6/30/13 based on primary taxonomy code in the National Plan and Provider Enumeration System (NPPES) The eligible professional does not have at least 100 Medicare Part B PFS cases containing an encounter code in the measure's denominator for dates of service from 1/1/13-6/30/13 The eligible professional does 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 does not have prescribing privileges and reported G8644 on a payable Medicare Part B service at least once on a claim between 1/1/13-6/30/13 The eligible professional submits at least 10 electronic prescriptions and reports the G-code (G8553) via claims during the 2013 eRx 6-month reporting period 1/1/13-6/30/13 The eligible professional achieves 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 attests during the 6-month reporting period (1/1/13- 6/30/13) The eligible professional demonstrates 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 The eligible professional submits one of the hardship exemption G-codes via any payable Medicare Part B PFS claim with a date of service during the 6-month eRx reporting period (1/1/13-6/30/13) The eligible professional requests and CMS approves a hardship exemption via the Physician Quality Reporting Communication Support Page (Communication Support Page) |
Group Practices
The following table, also extracted from the CMS fact sheet "2013 Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment," lists payment adjustment exclusion criteria for the Group Practice Reporting Option (GPRO). If any one of the following criteria applies, the negative eRx payment adjustment will not be applied in 2014.
| 2014 eRx Payment Exclusion Criteria: GPRO |
|---|
The group practice is a successful electronic prescriber during the 2012 eRx 12-month reporting period (1/1/12-12/31/12) The group practice does 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 2013 eRx GPRO submits the required number of electronic prescriptions according to size via claims during the eRx 6-month reporting period (1/1/13-6/30/13) The eRx GPRO (every NPI within the TIN) achieves 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 attests during the 6-month reporting period 1/1/13-6/30/13 The eRx GPRO (every NPI within the TIN) demonstrates intent to participate in the Medicare or Medicaid EHR Incentive Program by registering (providing EHR certification ID) and adopting certified EHR technology during the 6-month reporting period (1/1/13-6/30/13) The 2013 eRx GPRO requests a hardship exemption via the Communication Support Page |
*GPROs are analyzed at the Tax ID Number (TIN) level, using the TIN submitted when the group first self-nominated or registered.
*If an organization or eligible EP changes TINs, participation in the old TIN does not carry over to the new TIN, and results from both TINs are not combined for analysis.
Other Exceptions
The Centers for Medicare & Medicaid Services (CMS) has also identified two automatic exemptions for the 2014 eRx payment adjustment. These will automatically be processed by CMS.
- "Those eligible professionals and members within a group practice participating in eRx GPRO who achieve 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 attests during the 6-month reporting period (1/1/2013-6/30/13)"; and
- "Those eligible professionals and members within a group practice participating in eRx GPRO who demonstrate 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."
References:
- CMS fact sheet "2013 Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment"
- CMS eRx Incentive Program Web page
- CMS Quick-Reference Guide for Understanding the 2014 Electronic Prescribing (eRx) Payment Adjustment
- CMS fact sheet "Electronic Prescribing (eRx) Incentive Program: 2014 eRx Payment Adjustment Informal Review Made Simple"
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