E-Rx incentives

2014

The e-prescribing program does not have an incentive in 2014. Providers who did not e-prescribe in 2012 or 2013 will receive a 2 percent penalty in 2014 if they did not meet any of the following exemptions.

CMS Electronic Prescribing Program reporting options for avoiding 2 percent penalty in 2014:

If you Report Frequency Before
Successfully created an electronic prescription G8553 10 times June 30, 2013
Successfully created an electronic prescription  G8553 25 times Dec. 31, 2012
Did not have at least 100 claims containing an E/M code between Jan. 1-June 30, 2013 Nothing; CMS will automatically exempt you from the penalty in 2014. N/A June 30, 2013
Did not have prescribing authority G8644 1 time June 30, 2013
Was not a practicing MD, DO, NP, or PA  Nothing; CMS will automatically determine this based on NPPES user info. N/A June 30, 2013
Had less than 10 percent of your total allowed charges comprised of E/M codes between Jan. 1-June 30, 2013 Nothing; CMS will calculate this and exempt you from the penalty in 2014. N/A June 30, 2013
Successfully attested for meaningful use Nothing; CMS will calculate this and exempt you from the penalty in 2014. N/A Between Jan. 1 2012 and June 30, 2013
Registered for the EHR Incentive Program on the CMS website and adopted a certified EHR system Nothing; CMS will calculate this and exempt you from the penalty in 2014. N/A Between Jan. 1, 2013 and June 30, 2013
Practiced in a rural area without sufficient high-speed Internet access Attest on an online portal at www.qualitynet.org/portal/
server.pt/community/comm
unications_support_system/
234.

You can call the Quality Net
help desk at (866) 288-8912
or email qnetsupport@sdps.org.
One time June 30, 2013
Practiced in an area without sufficient access to pharmacies that accept electronic prescriptions
Were unable to e-prescribe due to local, state or federal laws (e.g. prescribe mainly narcotics)
Prescribed fewer than 100 total prescriptions between Jan. 1-June 30, 2013

2014 E-prescribing penalty informal review process

CMS will begin notifying providers on Jan. 1, 2014 if they are subject to the 2014 e-prescribing penalty through the remark code of "LE" on the Medicare Part B Explanation of Benefits (EOB) form. This form will also contain the following Claim Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC):

  • CARC 237 — Legilated/Regulatory Penalty
  • RARC N545 — Payment reduced based on status as an unsuccessful e-prescriber per the Electoronic Prescribing (eRx) Incentive Program

If you receive this remark code on your EOB and believe this determination is incorrect, you can file an informal appeal via email to eRxInformalReview@cms.hhs.gov. Please include your individual rendering National Provider Identifier (NPI), as well as your contact information, including email address, telephone number, and mailing address. You will need to state your justification about why you are requesting an informal review. Please note: Eligible professionals should not provide their Tax Identification Number (TIN) via email. Providers have until Feb. 28, 2014 to submit an appeal.

2013

All Medicare providers (e.g., physicians, NPs, PAs, etc.) are eligible to earn a 0.5 percent incentive on their total Medicare Part B allowed charges by electronically prescribing a total of 25 times from Jan. 1 to Dec. 31, 2013, 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.

Claims-based reporting options to receive the eRx 0.5 percent incentive for 2013:

Method Report Before
Claims G8553 along with the applicable E/M code* at least 25 times. Dec. 31, 2013
Registry Visit www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive/Registry-Reporting.html for more information about signing up with a CMS-approved registry. Dec. 31, 2013
EHR Contact your EHR vendor for reporting details. Dec. 31, 2013

*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.

Year Incentive** Penalty**
2013 .5 percent -1.5 percent
2014 0 percent -2 percent

**Percentage is based on total Medicare Part B allowed charges.

Note: If you plan to participate in the EHR incentive program in 2013, you will not be eligible to collect the 0.5 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. For more information, visit  the CMS website.

2012

2012 E-Prescribing Incentive Program

CMS began distributing incentive payments in August 2013 to providers who participated in the e-prescribing incentive program in 2012. Providers may visit the Quality Net Portal to access feedback reports explaining their participation in the program.

CMS contact information: To contact CMS directly about the EHR Incentive Program, call (888) 734-6433 between the hours of 7:30 a.m. to 6:30 p.m. CT, Monday through Friday.

AAD contact information: To contact Academy practice management staff, please call (866) 503-7546 or email hit@aad.org.