E-Prescribing Incentive Program Proposed Rule for 2011
By: Justin Vaughn, CPC, M.Div, Director of Compliance

The U.S. Congress has authorized a continuation of the Electronic Prescribing (eRx) incentive program for 2011.  As in the past, eligible providers (EPs) will have the opportunity to earn a financial bonus based on successful participation in the program.  However, the bonus for the 2011 reporting period will be only 1% of the total Medicare allowed charges for the year, as compared with 2% relative to the 2010 reporting period. 

To avoid any confusion, you should be aware that the eRx incentive program is separate and apart from the PQRI program.  Participation in one of these programs does not disqualify you from participating in the other.  However, you will not be eligible for the eRx bonus relative to the 2011 reporting period if you earn a bonus via participation in the 2011 EHR incentive program—yet another program that is distinct from PQRI and eRx (though the EHR program will be rolled into the PQRI program beginning in 2012).

In order to ensure successful participation in the eRx incentive program, the rule proposes that you meet the following criteria:

• Have an “approved” eRx system, or an EHR with approved eRx capabilities.  (System approval is based on a myriad of functionality requirements, which are outlined in detail in the Federal Register volume referenced below.)

• Use the approved eRx system to generate a prescription for at least 25 applicable patient encounters in 2011.  (An applicable encounter is defined by the eRx measure’s list of denominator codes.  Generally speaking, these codes would include, among others, typical E/M codes, such as office visit codes 99201-99215.)

• Signify the use of the eRx system during an applicable patient encounter by listing on the claim form (a) numerator code G8553, and (b) the applicable denominator code (see above).

• Ensure that allowed Medicare charges “for covered professional services to which the electronic prescribing quality measure applies” represent 10% or more of your total allowable charges for all Medicare services rendered in 2011.

There are several other stipulations found in the proposed rule, including a discussion of potential penalties for non-participation; however, it will be necessary to review the rule in its final form before a definitive description of such program elements can be provided.  The final rule is expected to be published within the next few weeks, and we will provide you an update at that time.  Until then, more details about the eRx incentive program, in general, can be found at http://www.cms.gov/ERXIncentive, while the proposed rule for 2011 can be found in its entirety in Vol. 75, No. 133, of the Federal Register, beginning at page 40202.

The information presented herein reflects general information that is current as of the date it was first published.  In light of changes that may occur in the health care regulatory and compliance environments, the author's presentation of this information might become outdated.  Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.