E-Prescribing Incentive complete information

Background

The MIPPA authorizes a new incentive program for eligible professionals who are successful electronic prescribers (E-Prescribers) as defined by MIPPA. This new incentive program is in addition to the quality reporting incentive program authorized by Division B of the Tax Relief and Health Care Act of 2006 – Medicare Improvements and Extension Act of 2006 (MIEA-TRHCA) and known as the Physician Quality Reporting Initiative (PQRI). 

The e-prescribing incentive is similar to the PQRI incentive in that reporting periods are one year in length and the incentive is based on the covered professional services furnished by the eligible professional during the reporting year . In addition, MIPPA requires that quality measures that can be reported for purposes of qualifying for the PQRI incentive payment not include e-prescribing measures

Reporting Periods

Reporting periods are for a calendar year, beginning with calendar year 2009 through 2013.

Incentive Amounts

The e-prescribing incentive amount is based on the Secretary’s estimate (based on claims submitted not later than 2 months after the end of the reporting period) of the allowed charges for all such Physician Fee Schedule (PFS) covered professional services furnished by the eligible professional during the reporting period. 

The e-prescribing incentive percent amount for reporting years 2009 - 2010 is 2.0 percent; for reporting years 201

1 - 2012 is 1.0 percent; and for reporting year 2013 it is 0.5 percent.

Incentive Limitations

The incentive does not apply to eligible professionals, for the reporting period, if:

1. The Medicare allowed charges for all covered professional services for the codes to which the e-prescribing

measure applies are less than 10% of the total of the allowed charges under Medicare Part B for all such covered

professional services furnished by the eligible professional.

OR

2. If determined appropriate by the Secretary, the eligible professional does not submit (including both electronically and non-electronically) a sufficient number of prescriptions under Part D

Successful Electronic Prescriber Defined

For purposes of qualifying for the incentive, an eligible professional shall be treated as a successful E-Prescriber for a reporting period if the eligible professional meets the requirements under (1) below , or if determined appropriate by the Secretary, the requirement described in (2) below.

1. The eligible professional reported the applicable e-prescribing quality measure (e.g., e-prescribing measure

# 125) in at least 50 percent of the cases in which such measure is reportable by the eligible professional during

the reporting year. Note: Any updates to e-prescribing quality measures (specifications and/or reporting

instructions) will be posted at http://www.cms.hhs.gov/ERxIncentive on the CMS website.

OR

2.  The eligible professional electronically submitted a sufficient number of prescriptions (as determined by the

Secretary) under Part D during the reporting period.

In addition, to the extent practical, in determining whether the eligible professional meets the criteria for

successful e-prescribing, the Secretary shall ensure that eligible professionals utilize e-prescribing systems in

compliance with standards established for such systems pursuant to the Part D Electronic Prescribing Program

under section 1860 D-4 of the SSA

Adjustment Amounts

With respect to covered professional services furnished by an eligible professional during 2012 or any subsequent year , if the eligible professional is not a successful E-Prescriber for the reporting period for the year

, the fee schedule amount for such services furnished by such professional during the year shall be reduced by:

• 1.0 percent for 2012,

• 1.5 percent for 2013, and

• 2.0 percent for 2014 and each subsequent year.

Hardship Exceptions

The Secretary may, on a case-by-case basis, exempt an eligible professional from the application of the payment

adjustment, if the Secretary determines, subject to annual renewal, that compliance with the requirement for being a successful E-Prescriber would result in a significant hardship