All Medicare providers (e.g. physicians, NPs, PAs, etc.) are eligible to earn a 1 percent incentive on their total Medicare Part B allowed charges by electronically prescribing a total of 25 times from Jan. 1 to Dec. 31, 2012, and reporting this to The Centers for Medicare and Medicaid Services (CMS) through their claims with the code G8553 along with the applicable E/M code*. Please note, you must e-prescribe for a Medicare Part B patient. Patients enrolled in Medicare Advantage plans are not eligible to be reported for the e-prescribing program.
Providers who successfully report this measure in 2012 also will be exempt from a 2.0 percent penalty in 2014. Additionally, providers who want to avoid a 1.5 percent penalty in 2013 must have reported the measure through their claims at least 10 times between Jan. 1 and June 30, 2012. CMS requires submission of documentation of e-prescribing through claims; providers are not allowed to use a registry or EHR to avoid the penalty in 2013.
Claims-based reporting options to receive the eRx incentive for 2012:
If you:
| Report: | Frequency: | Before: |
Successfully created an electronic prescription.
| G8553 along with the applicable E/M code*.
| 25 times
| Dec. 31, 2012
|
Claims-based reporting options to avoid the eRx penalty in 2013:
If you:
| Report: | Frequency:
| Before: |
| Successfully created an electronic prescription. | G8553 | 10 times
| June 30, 2012
|
Please note: You do not need to report the denominator code* along with G8553 for purposes of avoiding the penalty. CMS also has allowed providers to claim exemptions from the e-prescribing penalty in 2013:
| If you: | Report: | Before: |
Do not have at least 100 claims containing an E/M code* between Jan. 1-June 30, 2012.
| Nothing; CMS will calculate this and automatically exempt you from the penalty.
| June 30, 2012
|
Have less than 10 percent of your total allowed charges comprised of E/M codes* between Jan. 1-June 30, 2012.
| Nothing; CMS will calculate this and automatically exempt you from the penalty. | June 30, 2012 |
Do not have prescribing authority.
| G8644 | June 30, 2012
|
| Practice in a rural area without sufficient high-speed Internet access. | Attestation on the Quality Net website
Providers will be required to submit: - Identifying information including TIN, NPI, name, mailing address and e-mail address.
- Significant hardship exemption category that applies.
- A justification statement describing how the exemption category applies.
- An attestation as to the accuracy of the information provided.
| June 30, 2012 |
| Practice in an area without sufficient access to pharmacies that accept electronic prescriptions. |
| Prescribed fewer than 100 total prescriptions from Jan. 1 to June 30, 2012. |
| Are unable to e-prescribe due to local, state or federal laws (i.e. prescribe a large number of narcotics). |
*Eligible denominator codes include: 90801, 90802, 90804-90809, 90862, 92002, 92004, 92012, 92014, 96150-96152, 99201-99205, 99211-99215, 99304-99310, 99315, 99316, 99324-99328, 99334-99337, 99341-99345, 99347-99350, G0101, G0108 and G0109.
Note: If you plan to participate in the EHR incentive program in 2012, you will not be eligible to collect the 1 percent e-prescribing bonus. CMS does not allow physicians to collect both bonuses, however, NPs and PAs are not eligible for the Medicare EHR incentive program, so they can continue collecting the e-prescribing bonus. Additionally, at least 10 percent of your total Medicare Part B PFS allowed charges must be comprised of E/M codes to qualify for the bonus. For more information, visit www.aad.org/hitkit or the CMS website.
| Year | Incentive** | Penalty** |
| 2012 | 1 percent bonus | -1 percent |
| 2013 | .5 percent bonus/1.5 percent penalty* | -1.5 percent |
| 2014 | 0 percent | -2 percent |
**Percentage is based on total Medicare Part B allowed charges.
2012 e-prescribing penalty
The American Medical Association (AMA) has worked with CMS to provide additional exemptions to providers for the 2012 e-prescribing penalty. You must contact CMS’s Quality Net help desk immediately if you have not received a formal notice from CMS regarding the final status of your exemption request or if you believe you are receiving the 2012 e-prescribing penalty in error. You can call the Quality Net help desk at (866) 288-8912 or email qnetsupport@sdps.org. You also can visit the AMA's website for more information.
2011 e-prescribing incentive program
CMS began distributing incentive payments in September 2012 to providers who participated in the e-prescribing incentive program in 2011. Providers may visit the Quality Net Portal to access feedback reports explaining their participation in the program.