Medicare ePrescribing Incentives
Legislation: The Medicare Improvements for Patients and Providers Act (MIPPA)
The ePrescribing incentive program ends after 2014—the last incentives will be earned in 2013 and penalties for non-participation will be incurred through 2014, according to the chart below. Incentives and panalties are calculated as a percentage of estimated total Medicare Part B Fee-For-Service Allowed Charges submitted by the end of February of the following year, according to the following schedule:
|Year||ePrescribing Bonus||Non-ePrescribing Penalty|
|2009||2% - paid Fall 2010
|2010||2% - paid Fall 2011
|2011||1% - paid Fall 2012||–|
|2012||1% - to be paid Fall 2013
How to Earn the 2013 ePrescribing Incentive:
ePrescribe and use G-code 8553 on 25 Medicare claims with the specified CPT codes* (below) between January 1 and December 31, 2013.
Note: The ePrescribing incentive is only available to providers who do not earn an EHR (meaningful use) incentive in the same year. Therefore physicians who are not pursuing meaningful use and those providers who are not meaningful-use-eligible but do prescribe, (e.g., PAs, NPs, PTs), can earn a 0.5% ePrescribing incentive this year.
2014 ePrescribing Penalty Avoidance:
Program-eligible providers who have completed any one of the following actions have successfully avoided the 2014 ePrescribing penalty:
- ePrescribed and used the code G-8553 on 25 Medicare encounters (with specified CPT codes) between January and December 2012
- ePrescribed and used the code G-8553 on 10 Medicare encounters (with any CPT codes) between January 1 and June 30, 2013
- Earned a 2012 Meaningful Use (EHR) Incentive or earned a 2013 Meaningful Use (EHR) Incentive by June 30, 2013
- Adopted a certified EHR and registered for the EHR Incentive Program for the first time between January 1 and June 30, 2013
- Requested a Hardship Exemption by June 30, 2013.
- Submitted G-8642 to indicate practicing in a rural area, G-8643 to indicate insufficient pharmacies, or G-8644 to indicate lack of prescribing privileges. (The relevant code only needed to be submitted on one Medicare claim during the reporting period.)
MIPPA ePrescribing Requirements:
1. Eligibility: Eligible providers include Medicare physicians (MDs, DOs, podiatrists, optometrists, dentists, chiropractors) and practitioners (physician assistants, nurse practitioners, nurse specialists, and others), as long as they have prescribing authority.
3. Specified CPT codes* make up 10% or more of practitioner’s total Part B claims:
- 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
4. “G-code” G-8553 (ePrescribed) is submitted at least 25 times during the year on claims for the CPT codes specified above.
- Use G-8553 to report that at least one prescription was generated and transmitted using a qualified ePrescribing system during the patient encounter.
5. Reporting is claims-based; no program registration is required.
For more information:
- Learn about physician productivity-focused ePrescribing
- CMS website: http://cms.hhs.gov/ERXIncentive
- For claims-based reporting instructions: CMS Download
- DEA Rule on ePrescribing for Controlled Substances, issued March 31, 2010
- DEA Proposed Rule: General Questions and Answers
- Surescripts website: www.surescripts.com
- For concerns about ePrescribing results: Contact QualityNet Help Desk at 866-288-8912 or email@example.com
- E-mail questions to GovtAffairs@srssoft.com