E-RX

Electronic prescribing, also known as e-prescribing or "e-Rx," is a prescriber's ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care. Erx technologies are often part of an EHR system, but they can also be purchased as a stand-alone system, therefore, you do not need to have an Electronic Health Record (EHR) to e-prescribe. Many times you can download e-prescribing programs from the internet right to your desktop. Some e-prescribing programs are free, and some are not. More information on e-prescribing will be posted to this site periodically.

2013 ELECTRONIC PRESCRIBING (eRx) INCENTIVE PROGRAM OVERVIEW FOR OPHTHALMIC PRACTICES

ASCRS/ASOA compiled the eRx Incentive Program Guide for Ophthalmic Practices to assist our members in understanding the eRx program and provide a one-stop resource for eligible professionals (EPs). The Medicare e-Rx program, which pays EPs who successfully e-prescribe, bonuses through 2013. Physicians who don't e-prescribe by 2013 will see a 1% reduction in Medicare payment that increases to 2% in 2014 and each subsequent year. We have summarized the program and provided links to the relevant CMS webpages. You may also go directly to the CMS eRx Incentive Program website to obtain more information.

Contents:

1.        How to Get the 2013 Payment Incentive

2.        How to Avoid the 2014 Payment Reduction

3.        Reporting To Receive The E-Rx Incentive (Bonus) And Avoid The Reduction

4.       Reporting To Only Avoid The E-Rx Reduction (Will Not Receive A Bonus)

5.        Payment Reduction Exemptions

6.       Reporting Mechanisms

7.        eRx System Requirements

8.       Participating In eRx, PQRS, and EHR

9.       Informal Review

10.     2014 Electronic Prescribing (Erx) Payment Adjustment Feedback Report

Successful E-Prescribing

How to Get an eRx Incentive Payment in 2013?

• 2013-Incentive is 0.5% of the EPs total estimated Medicare Part B allowed charges
• 2013-Reporting minimum is 25 unique encounters
• 2013-Reporting Period is January 1, 2013 through December 31, 2013

• for at least 625 unique visits for group practices comprised of 25-99 EPs
• for at least 2,500 unique visits for group practices comprised of 100 or more EPs
   

If you submitted submitted a minimum of 10 eRx codes (G8553) on your Medicare Part B claim forms, for any Medicare Part B physician fee schedule service provided between January 1, 2012 to June 30, 2012, using a qualifying eRx system or certified electronic health record (EHR), and the claims were received and processed by CMS by no later than July 31, 2012, you are a successful prescriber in 2012.

If you submitted 25 eRx claims (must be denominator eligible) between July 1, 2012 and December 31, 2012, becoming eligible for the 1% incentive for 2012, and avoiding an eRx penalty in 2014, using a qualifying eRx system or certified electronic health record (EHR), you are a successful prescriber in 2012.

All claims adjustments, re-openings, or appeals processed by the Carrier or A/B MAC must reach the national Medicare claims system data warehouse (National Claims History [NCH] file) by February 22, 2013 to be included in the 2012 eRx Incentive Program analysis.

Qualifying for an Exemption

Physicians may request a waiver of the 2014 penalty, by June 30, 2013, under any of the following categories:

• The physician is unable to e-prescribe as a result of local, state or federal law or regulation.
• The physician wrote fewer than 100 prescriptions during the period of Jan. 1–June 30, 2012.
• The physician practices in a rural area that doesn't have sufficient high-speed Internet access.
• The physician practices in an area that doesn't have enough pharmacies that can do e-prescribing.
• **New** - Successfully achieving Meaningful Use in the CMS Electronic Health Record (EHR) Meaningful Use Incentive Program
• **New** - Demonstrating intent to participate in the EHR Incentive Program for the first time by registering for the program and adopting certified EHR technology. (Physicians do not need to apply for an exemption related to these meaningful use hardship categories; CMS will automatically determine whether physicians meet those requirements.)

Submitting an Exemption Request

Go to the Quality Reporting Communication Support Page to request a significant hardship exemption for the 2013 eRx payment adjustment. CMS notified ASCRS that EPs who use Apple computers may experience technical problems and encourages them to contact the Help Desk for assistance.

Important Things to Remember

• Practice office staff can request a hardship exemption on behalf of the eligible professional.
• Physician Assistants (PA)—subject to payment adjustment
• Nurse Practitioners (NP)—subject to payment adjustment
• Optometrists—NOT subject to payment adjustment; Eligible to receive bonus
• Refills are not eligible.
• OTCs are eligible.
• “Unique” in this context means encounters, not patients or prescriptions. So you could file an eRx code for the same patient for two separate denominator-eligible visits, but not for two prescriptions issued during the same denominator-eligible visit.
• Claims filed for events that are not denominator-eligible do not count for the incentive, only for the penalty.
• Review your remittance advice: It must have the N365 code, your indication that the G8553 code passed into the Medicare National Claims History (NCH) database.
• Exemption applications cannot be submitted via mail, email, or fax. 

Resources

ASCRS/ASOA ErX Overview for Ophthalmic Practices

Quality Support Page User Manual 

ASCRS/ASOA eRx Webpage

CMS eRx Home Page

  
If you have questions regarding the eRx Incentive Program, eRx payment adjustments, or need assistance submitting a hardship exemption request, please contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or via qnetsupport@sdps.org. They are available Monday through Friday from 7:00 a.m.-7:00 p.m. CST.