2010 Medicare E-Prescribing Incentive Program

New! In 2010 ACR members can report to the e-Prescribing Incentive Program using ACR's Rheumatology Clinical Registry (RCR). Click here for more information or to begin.

In order to promote the adoption and use of e-prescribing systems, the "Medicare Improvements for Patients and Providers Act of 2008" authorized an e-prescribing incentive program beginning January 1, 2009.

This program will provide eligible professionals who successfully e-prescribe an incentive of two percent of the total estimated allowed charges for professional services covered by Medicare Part B and furnished by an eligible professional during the reporting period of one calendar year.

This incentive payment of two percent will continue into 2010, and will then be reduced to an incentive of one percent for the years 2011 and 2012, and finally 0.5 percent for the year 2013. Beginning in 2012, eligible professionals who are not "successful e-prescribers" will be subject to a penalty of -1 percent in the year 2012, -1.5 percent for the year 2013, and -2 percent for the year 2014.

This program removes the e-prescribing quality measure from the Physician Quality Reporting Initiative, and creates a separate incentive program based solely on electronic prescribing. As these are two independent programs, you will not be penalized for participating in one program, but not the other. This also means that an eligible professional can potentially get two incentive payments: one for being a "successful e-prescriber" and one for satisfactorily submitting data on other quality measures under the PQRI.

Who is eligible?

An eligible professional is one who currently uses, or has used, a qualified e-prescribing system, and whose estimated Part B charges for the e-prescribing measure codes are at least 10 percent of their total Part B allowed charges.

Who is a “successful” e-prescriber?

A successful e-prescriber must generate and report one or more eRxs associated with a patient visit, a minimum of 25 unique visits per year during the reporting year.

How do I know if an e-prescribing system is qualified?

Qualified systems are capable of all of the following:

• Generating a complete active medication list that incorporates electronic data received from applicable pharmacies and benefit managers (PBMs), if available.
• Selecting medications, print prescriptions, electronically transmit prescriptions, and conduct all alerts.
• Providing information related to lower cost, therapeutically appropriate alternatives (if any). Note: The availability of an e-prescribing system to receive tiered formulary information, if available, would meet this requirement.
• Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient's drug plan.

For more information on securing an electronic prescribing system or verifying that your current system is in compliance, click here.

How do I report the e-prescribing measure?

The measure includes both a denominator HCPCS code and a numerator G-code that is to be reported, on the claim for each patient visit during the reporting period that meets the denominator coding criteria.

The incentive will be paid to those professionals whose e-prescribing measure denominator codes are at least 10 percent of their total Part B allowed charges. Even if you are not sure if the Medicare service you bill for with these denominator codes will exceed 10 percent of your Medicare revenues, you should report the e-prescribing codes.

To report via claims, simply:

• Bill on one of the following 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 G0109

• If you employ a qualified e-prescribing system, report the following numerator G-code if it applies to the patient visit:

  Code	Description
  G8553	At least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system.

To report via registry using the RCR, submit records for at least 25 unique Medicare Part B patients with the applicable denominator codes for visits during the 2010 calendar year. For each patient, attest that at least one prescription created during the encounter was generated and transmitted electronically using a qualified e-prescribing system. Note that you can retrospectively submit 2010 e-prescribing data using the RCR (entering information about patient visits that occurred in the past) and data can be entered until January 31, 2011.

For more information on the e-prescribing quality measure, the associated codes, and the procedures for reporting data on the quality measure, visit www.cms.hhs.gov/PQRI. Select “E-prescribing Incentive Program,” or contact Itara Barnes in the ACR's Quality and Health Informatics department at .