Electronic Prescribing (erx) Incentive Program
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1 Electronic Prescribing (erx) Incentive Program 4
2 Electronic Prescribing (erx) Incentive Program Overview Established in 2009, the erx Incentive Program seeks to encourage the use of electronic prescribing by providing incentives and payment adjustments based on whether eligible meet the criteria for being successful electronic prescribers The applicable erx incentive amounts are as follows: 2.0 percent for percent for percent for percent for percent for 2011 The applicable erx payment adjustment amounts are as follows: 1.0 percent in percent in percent in 2013 There are no incentives or payment adjustments scheduled past 2014 This CY 2012 Physician Fee Schedule (PFS) final rule sets forth the requirements for the 2012 and 2013 incentives and 2013 and 2014 payment adjustments Website: 5
3 The Electronic Prescribing Measure The electronic prescribing measure contains a numerator and denominator Numerator Code: G8553 Denominator 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, and G0109 6
4 2012 and 2013 erx Incentives Criteria for Being a Successful Electronic Prescriber for the 2012 Incentive Individual Eligible Period Mechanism Criteria EHR (Direct EHR & EHR data submission vendor) 25 unique denominatoreligible 25 unique denominatoreligible 25 unique denominatoreligible Criteria for Being a Successful Electronic Prescriber for the 2013 Incentive Individual Eligible Period Mechanism Criteria 25 unique denominatoreligible 25 unique denominatoreligible EHR (Direct EHR & EHR data submission vendor) 25 unique denominatoreligible 7
5 2012 and 2013 erx Incentives Criteria for Being a Successful Electronic Prescriber for the 2012 Incentive Group Practices Using the erx GPRO Group Practice Size Period Mechanism Criteria for Being a Successful Electronic Prescriber 625 unique denominator-eligible 625 unique denominator-eligible reporting & EHR Data Submission Vendor) 625 unique denominator-eligible Jan1, 2012 reporting & EHR Data Submission Vendor) 8
6 2012 and 2013 erx Incentives 2013 Incentive: Criteria for Being a Successful Electronic Prescriber Group Practices Using the erx GPRO Group Practice Size Period Mechanism Criteria for Being a Successful Electronic Prescriber 625 unique denominator-eligible 625 unique denominator-eligible reporting & EHR Data Submission Vendor) 625 unique denominator-eligible reporting & EHR Data Submission Vendor) 9
7 2013 and 2014 erx Payment Adjustments Criteria for Being a Successful Electronic Prescriber for the 2013 erx Payment Adjustment Individual Eligible Period (Jan 1, 2011-* Mechanism * Criteria Reports on the 2011 electronic prescribing measure s numerator code at least 25 times for encounters associated with at least 1 of the denominator codes (the same criteria as the 2011 erx incentive)* (Jan 1, 2011-* * Reports on the 2011 electronic prescribing measure s numerator code at least 25 times for encounters associated with at least 1 of the denominator codes (the same criteria as the 2011 erx incentive)* (Jan 1, 2011-* EHR* Reports on the 2011 electronic prescribing measure s numerator code at least 25 times for encounters associated with at least 1 of the denominator codes (the same criteria as the 2011 erx incentive)* (Jan 1, 2012-Jun 30, 2012) Report the electronic prescribing measure's numerator code at least 10 times *Established in the CY 2011 PFS final rule with comment period. 10
8 2013 and 2014 erx Payment Adjustments Criteria for Being a Successful Electronic Prescriber for the 2014 erx Payment Adjustment Individual Eligible Period Mechanism Criteria (Jan 1, 2012-) Reports on the 2011 electronic prescribing measure s numerator code at least 25 times for encounters associated with at least 1 of the denominator codes (the same criteria as the 2012 erx incentive) (Jan 1, 2012-) Reports on the 2011 electronic prescribing measure s numerator code at least 25 times for encounters associated with at least 1 of the denominator codes (the same criteria as the 2012 erx incentive) (Jan 1, 2012-) (Jan 1, 2013-Jun 30, 2013) EHR (Direct EHR & EHR data submission vendor) Reports on the 2011 electronic prescribing measure s numerator code at least 25 times for encounters associated with at least 1 of the denominator codes (the same criteria as the 2012 erx incentive) Report the electronic prescribing measure's numerator code at least 10 times 11
9 2013 erx Payment Adjustment Criteria for Being a Successful Electronic Prescriber for the 2013 Payment Adjustment Group Practices Using the erx GPRO Group Practice Size Period Mechanism Criteria 2-10 Eligible,, or EHR* 75 times for as the 2011 GPRO II erx incentive) Eligible,, or EHR* 225 times for as the 2011 GPRO II erx incentive) Eligible,, or EHR* 475 times for as the 2011 GPRO II erx incentive) Eligible,, or EHR* 925 times for as the 2011 GPRO II erx incentive) Eligible,, or EHR* 1,875 times for as the 2011 GPRO II erx incentive) 200+ Eligible,, or EHR* 2,500 times for as the 2011 GPRO I erx incentive) Eligible 100+ Eligible (Jan 1, Jun 30, 2012) ( Jun 30, 2012) * Established in the 2011 PFS Final Rule. Report the electronic prescribing measure's numerator code at least 625 times Report the electronic prescribing measure's numerator code at least 2,500 times 12
10 2014 erx Payment Adjustment Criteria for Being a Successful Electronic Prescriber for the 2014 Payment Adjustment Group Practices Using the erx GPRO Group Criteria Practice Size Period Mechanism Eligible ( 625 times for Eligible Eligible 100+ Eligible 100+ Eligible 100+ Eligible Eligible 100+ Eligible ) ( ) ( ) ( ) ( ) ( ) (Jan 1, Jun 30, 2013) (Jan 1, Jun 30, 2013) reporting & EHR Data Submission Vendor) reporting & EHR Data Submission Vendor) as the 2012 erx incentive) 625 times for as the 2012 erx incentive) 625 times for as the 2012 erx incentive) 2,500 times for as the 2012 incentive) 2,500 times for as the 2012 incentive) 2,500 times for as the 2012 incentive) Report the electronic prescribing measure's numerator code at least 625 times Report the electronic prescribing measure's numerator code at least 2,500 times 13
11 Electronic Prescribing (erx) Incentive Program 2013 and 2014 erx Payment Adjustments Significant Hardship Exemptions: The eligible professional or group practice practices in a rural area with limited highspeed Internet access The eligible professional or group practice practices in an area with limited available pharmacies for electronic prescribing Inability to electronically prescribe due to local, state, or federal law or regulation Eligible who prescribe fewer than 100 prescriptions during a, payment adjustment reporting period Deadline to submit requests for significant hardship exemptions: 2013 Payment Adjustment: June 30, Payment Adjustment: June 30, 2013 Method of Submission: Communication Support Page (web-based tool) Link: The Communication Support Page will be available to accept requests for significant hardship exemptions in the Spring
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