Medicare ePrescribing Incentives
Calculated as a percentage of estimated total Medicare Part B Fee-For-Service Allowed Charges submitted by 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
Legislation: The Medicare Improvements for Patients and Providers Act (MIPPA)
Note: ePrescribing incentives are only available to providers who do not earn an EHR (meaningful use) incentive in the same year. All program-eligible providers, however, are subject to the MIPPA penalties unless they satisfy one of the options listed below.
How to Earn the 2013 ePrescribing Incentive:
ePrescribe and use G-code 8553 on 25 Medicare claims with the specified CPT codes between January 1 and December 31, 2013.
How to Avoid 2013 and 2014 ePrescribing Penalties:
|ePrescribe(d) on 25 Medicare encounters (specified CPT codes) using G-8553||Jan. – Dec. 2011
||Jan. – Dec. 2012|
|ePrescribe(d) on 10 Medicare encounters (any CPT codes) using G-8553||Jan. – June 2012
||Jan. – June 2013|
|Earn Meaningful Use (EHR) Incentive||For 2011
by June 30, 2012
by June 30, 20131
|Adopt Certified EHR and Register for EHR Incentive Program2||By Jan. 31, 2013||By June 30, 2013|
|Request Hardship Exemption3||By Jan. 31, 2013||By June 30, 2013|
1 If you plan to earn a 2013 EHR incentive for a 90-day reporting period that occurs later in 2013, see line below in the above chart, i.e., be sure to register for the CMS Incentive
Program by June 30, 2013, even though you can attest for 2012 until February
2 Register on the CMS EHR Incentive Registration and Attestation System. Registration must include EHR Certification #.
3 To file an exemption request, use the form located on the CMS QualityNet website. Justifications include a predominance of prescriptions for controlled substances, writing fewer than 100 Rx’s in the 6-month reporting period, insufficient internet access, or a limited number of pharmacies that accept prescriptions electronically.
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.
Note: Providers who are eligible for the ePrescribing program but not eligible for Meaningful Use incentives, (e.g., RNs, NPs, PAs), may still be subject to MIPPA penalties in 2013 and 2014.
2. Use of qualified system (Surescripts certification includes many of the required capabilities):
- Generates an active medication list for the patient.
- Allows electronic selection of medications, prescription generation, and transmission.
- Conducts all alerts, including automated prompts that warn of potentially inappropriate doses or routes of administration, drug-drug interactions, allergy concerns, and other warnings/cautions.
- Provides information on lower cost therapeutically appropriate alternatives, if any.
- Provides information on formulary or tiered formulary medications, patient eligibility and authorization requirements received electronically from the patient’s drug plan, if available.
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” G8553 (ePrescribed) is submitted at least 25 times during the year on claims for the CPT codes specified above.
- Report G8553 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 required.
For more information:
- Learn about physician productivity-focused ePrescribing
- CMS website: http://cms.hhs.gov/ERXIncentive
- For claims-based reporting instructions: CMS Download
- Medicare Part B Rule 2012
- 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 firstname.lastname@example.org
- E-mail questions to GovtAffairs@srssoft.com