E E l l e e c c t t r r o o n n i i c c P P r r e e s s c c r r i i b b i i n n g g ( ( e e R R x x ) ) I I n n c c e e n n t t i i v v e e P P r r o o g g r r a a m m
Published July 2011
Part B
IMPORTANT
The information provided in this manual was current as of June 2011. Any changes or new information superseding the information in this manual, provided in
newsletters/eBulletins, MLN articles, listserv notices, Local Coverage Determinations (LCDs) or CMS Internet-Only
Manuals with publication dates after June 2011, are available at:
http://www.trailblazerhealth.com/Medicare.aspx
© CPT codes, descriptions, and other data only are copyright 2010 American Medical Association. All rights reserved. Applicable FARS/DFARS clauses apply. © CDT codes and descriptions are copyright 2010 American Dental Association. All rights reserved. Applicable FARS/DFARS clauses apply.
Provider Outreach and Education KL
IMPORTANT
Table of Contents
ERX BACKGROUND... 1
Definition... 1
eRx Overview ... 1
Qualified eRx System Requirements ... 2
Questions to Consider When Selecting an eRx System ... 2
ELIGIBLE PROFESSIONALS ... 3
Measure Instructions ... 4
Hardship Codes ... 8
Medicare Part B Claim Submission ... 9
Qualified Registry ... 12
Qualified EHR ... 13
Group Practice Reporting Option (GPRO)... 13
eRx Incentive Payment... 16
eRx Successful Reporting ... 16
Future Penalties for Not Electronically Prescribing ... 17
eRx Reporting Period ... 18
eRx Feedback Reports ... 18
Original/Group TIN Process... 19
IACS Information and Steps to Accessing Feedback Reports... 20
Obtaining Feedback Reports ... 21
Additional eRx Online Resources ... 22
REVISION HISTORY ... 23
eRx BACKGROUND
Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes a separate incentive program for eligible professionals who are successful electronic prescribers as defined by MIPPA. This is a separate incentive and is in addition to the Physician Quality Reporting System (Physician Quality Reporting) program. Eligible professionals do not have to be reporting in the Physician Quality Reporting program to participate in the eRx Incentive program.
For 2011, a 1 percent incentive payment can be paid to eligible professionals who successfully prescribe (as defined by the statute) their patient’s medications via a qualified eRx system.
Definition
eRx is a prescriber’s ability to electronically send an accurate, error-free and
understandable prescription directly to a pharmacy from the point-of-care and is an important element in improving the quality of patient care.
eRx Overview
eRx is no longer included in the Physician Quality Reporting Measures List.
The eRx incentive is 1 percent of the Physician Fee Schedule (PFS) allowed amount.
The incentive is only available to authorized prescribers under their state laws.
eRx does not require the provider to participate in the Physician Quality Reporting program.
Eligible professionals may participate in either or both incentive programs and could potentially receive two incentive payments.
eRx has no sign-up or registration to participate in the program.
Eligible professionals must have a qualified system to participate.
eRx can be reported:
o On Medicare Part B claims.
o To a qualified registry.
o Through a qualified Electronic Health Record (EHR) product.
Ten percent of a successful electronic prescriber’s Medicare Part B covered services must be made up of codes that appear in the eRx measure.
Medicare Advantage plans are not eligible for this incentive; only Medicare Part B qualifies.
Beginning in 2012, eligible providers who are not successful electronic providers may be subject to payment adjustments (payment reductions). Those not
successful will see a reduction in the PFS amount of 1 percent.
Note: Eligible providers must have and use a qualified eRx system. Faxing a
prescription to a pharmacy does not qualify as eRx. If the system in question only has the ability to send a fax to the pharmacy, the system does not quality as an eRx system.
Qualified eRx System Requirements
Generate a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers (if available).
Select medications, print prescriptions, electronically transmit prescriptions and conduct all alerts.
Provide information related to lower-cost therapeutically appropriate alternatives (if any).
Provide information on formulary or tiered formulary medications, patient
eligibility and authorization requirements received electronically from the patient’s drug plan (if available).
Note: A qualified eRx system is one that is capable of all of the requirements listed above.
In addition to the system functionalities mentioned above, the system must employ, for the capabilities listed, the eRx standards adopted by the Secretary for Part D by virtue of the 2003 Medicare Modernization Act (MMA).
Access http://www.regulations.gov and search for “Part D Prescribing.”
Questions to Consider When Selecting an eRx System
What type of system would best “fit” your practice?
o Stand-alone eRx system.
o EHR that includes eRx capability.
What type of system updates will be in the purchase package?
How does the system link to the Medicare Part D prescription formulary?
Remember the system must also meet requirements related to the Medicare Part D standards published in the 2003 Medicare Modernization Act (MMA).
Will the eRx system run under the existing computer programming currently in place in the office?
ELIGIBLE PROFESSIONALS
Under the eRx Incentive Program, covered professional services are those paid under the Medicare Physician Fee Schedule. To the extent that the eligible professionals are providing services that are paid under the fee schedule, those services are eligible for the eRx program.
The following are eligible to participate in eRx and must have prescribing authority to participate:
Medicare physicians:
Doctor of medicine.
Doctor of osteopathy.
Doctor of podiatric medicine.
Doctor of optometry.
Doctor of oral surgery.
Doctor of dental medicine.
Doctor of chiropractic.
Practitioner:
Physician assistant.
Nurse practitioner.
Clinical nurse specialist.
Certified registered nurse anesthetist (and anesthesiologist assistant).
Certified nurse midwife.
Clinical social worker.
Clinical psychologist.
Registered dietitian.
Nutrition professional.
Audiologists.
Therapists:
Physical therapist.
Occupational therapist.
Qualified speech-language therapist.
One of the first steps a provider should take is to review the eRx measure in its entirety to ensure all components of the measure can be met by the eligible professional. The measure can be found on the CMS eRx Web site at:
http://www.cms.gov/ERxIncentive/Downloads/2011_eRxMeasure_ReleaseNotes_Claim sBasedReportingPrinciples111010.zip
Measure Instructions
To report the eRx measure, a qualified eRx system that meets all the requirements must have been adopted. The measure is to be reported for those patient visits that meet the denominator (the eligible cases, e.g., Evaluation and Management (E/M) code(s)) coding criteria for which an individual eligible professional has electronically prescribed at least one prescription for a patient with Medicare Part B. Denominator coding criteria for this measure include various ambulatory care settings. There is no specific diagnosis required for this measure. The diagnosis associated with the patient encounter that requires the eRx may be used to report the eRx numerator (eRx
designated procedure code) “G” code. Individual eligible professionals who generate at least one electronic prescription associated with a patient visit on 25 or more unique events during the reporting period (January 1 through December 31) will be considered successful electronic prescribers and incentive-eligible if at least 10 percent of their Medicare Part B charges is made up of the codes in the denominator of the measure.
Excerpts of the 2011 eRx measure are detailed below, by section, as an educational tool.
The measure will provide the current year reporting options along with detailed system requirements.
The measure also provides instructions specific to the eRx measure.
The measure will also provide the reporting options for the measure.
Claim Reporting: Submit both a denominator CPT code and the numerator “G”
code on the Medicare Part B claim. All measure-specific coding should be reported on the same claim (faxes do not qualify as eRx).
Registry Reporting: A denominator CPT code and an electronically generated and transmitted prescription (not faxed) are required to report the measure. This information is transferred (based on individual registry requirements) to a
qualified and CMS-approved registry.
Reporting Denominator
The denominator is made up of CPT or HCPCS codes. One or more of the denominator codes must be included on the claim along with the eRx measure.
Reporting Numerator
The numerator indicates a qualified system has been adopted and an eRx event occurred during the patient visit (listed as a qualified denominator).
Rationale
The measure also provides the rationale that was put into the development and implementation of the eRx measure.
The measure is then completed with a section listing definitions to various terms used within the measure and a section for evidence supporting the criterion of the quality measure.
Definitions
Electronic Prescribing (eRx) – The transmission, using electronic media, of prescription or prescription-related information between a prescriber, dispenser, pharmacy benefit manager or health plan either directly or through an intermediary, including an eRx network. eRx includes, but is not limited to, two-way transmission between the point of care and the dispenser. (Faxes initiated from the eligible professional’s office do not qualify as eRx.)
Electronic Prescribing (eRx) Event – For the purposes of this measure, an eRx event includes all prescriptions electronically prescribed during a patient visit.
Successful Individual Electronic Prescriber Incentive Eligible – A successful individual electronic prescriber, eligible to receive an incentive payment, must generate and report one or more electronic prescriptions associated with a patient visit for a minimum of 25 unique visits per year. Each visit must be accompanied by the eRx “G”
code attesting that during the patient visit at least one prescription was electronically
prescribed. Electronically generated prescriptions not associated with a denominator- eligible patient visit do not count toward the minimum of 25 different eRx events.
Additionally, 10 percent of an eligible professional’s Medicare Part B charges must comprise the codes in the denominator of the measure to be incentive-eligible.
Alerts – Written or acoustic signals to warn the prescriber of possible undesirable or unsafe situations, including potentially inappropriate dose or route of administration of a drug, drug-drug interactions, allergy concerns, or warnings and cautions.
Durable Medical Equipment (DME) Supplies – Prescriptions for diabetic supplies may be electronically prescribed. Some pharmacies may require additional documentation secondary to internal policies that may be mandatory in case of audits; others may require a signed copy of the order with signature to be kept for verification purposes.
Evidence Supporting the Criterion of the Quality Measure
The individual measure located on the CMS eRx Web site provides detailed information on all of the criteria used in the development and publication of this measure. The entire supporting criteria are located at the end of the eRx measure on the CMS Web site at:
http://www.cms.gov/ERxIncentive/06_E-Prescribing_Measure.asp#TopOfPage The next step is reporting the measure, either to Medicare via the Medicare Part B claim, to a qualified registry, or through a qualified Electronic Health Record (EHR) product.
Hardship Codes
CMS has introduced new codes, referred to as hardship codes, which should be reported at least one time on a denominator-eligible claim during the 2012 payment adjustment reporting period (if applicable). The payment adjustment period for 2011 is considered January 1, 2011, through June 30, 2011. During this time period, if eligible providers do not report eRx services, those providers will receive a 1 percent physician fee schedule adjustment (fee schedule reductions) in the year 2012.
These codes should be used when an eligible professional wishes to request a significant hardship exemption from the application of the 2012 payment adjustment because the provider is unable to submit electronic prescriptions due to some type of system hardship.
Examples of system hardship:
Rural area without Internet access.
Limited pharmacies accepting eRx.
Does not have prescribing privileges.
Hardship Codes
G8642 The eligible professional practices in a rural area without sufficient high-speed Internet access and requests a hardship exemption from the application of the payment adjustment under Section 1848(a)(5)(A) of the Social Security Act.
G8643 The eligible professional practices in an area without sufficient available pharmacies for eRx and requests a hardship exemption from the application of payment adjustment under Section
1848(a)(5)(A) of the Social Security Act.
G8644 may be used when an eligible professional does not have prescribing privileges.
If this code is used, the eligible professional may not be considered for a payment adjustment.
Medicare Part B Claim Submission
Correct claim submission is vital to being successful and receiving the eRx incentive payment. The following is required for eRx claim submission:
Report the following e-Rx numerator “G” code, when applicable:
o G8553 should be reported when at least one prescription was created during the patient encounter and the prescription was generated and transmitted electronically using a qualified eRx system.
The “G” code, which supplies the numerator, must be reported:
o On the same claim as the denominator billing code.
o For the same beneficiary.
o For the same date of service.
o By the same eligible professional (individual National Provider Identifier (NPI)) who performed the covered service as the payment codes, usually ICD-9-CM, CPT Category 1 or HCPCS codes, which supply the denominator.
The “G” code must be submitted with a line-item charge of zero dollars at the time the associated covered service is performed:
The submitted charge field cannot be left blank.
The line item charge should be $0.00.
If a system does not allow a $0.00 line-item charge, a nominal amount can be substituted – the beneficiary is not liable for this nominal amount.
Entire claims with a zero charge will be rejected. (The total charge for the claim cannot be $0.00.)
Whether a $0.00 charge or a nominal amount is submitted, the “G” code line is denied and tracked.
eRx line items will be denied for payment, but are passed through the claims processing system to the National Claims History (NCH) database, used for eRx claims analysis. Eligible professionals will receive a remittance advice that includes a standard remark code (N365). N365 reads: “This procedure code is not payable. It is for reporting/information purposes only.” The N365 remark code does not indicate whether the “G” code is accurate for that claim or for the
measure the eligible professional is trying to report. N365 only indicates the “G”
code passed into NCH.
When a group bills, the group NPI is submitted at the claim level; therefore, the individual rendering/performing physician’s NPI must be placed on each line item, including all allowed charges and quality-data line items.
Solo practitioners should follow their normal billing practice of placing their individual NPI in the billing provider field (Item 33a of the CMS-1500 claim form or the electronic equivalent).
Claims may not be resubmitted for the sole purpose of adding or correcting an eRx code.
In an effort for CMS to determine those providers who will receive the physician fee schedule adjustment (reduction) in 2012, claims data will be analyzed from January 1, 2011, through June 30, 2011. Eligible providers must submit at least 10 electronic prescriptions during the first six months of calendar year 2011 to prevent being considered for the payment reduction the following year.
If the provider meets the hardship requirement, one of the hardship codes should be reported at least one time on a denominator-eligible claim during January 1, 2011, through June 30, 2011 (if applicable).
The timeliness of the quality data submission requires that the claims be processed by Medicare and must reach the national Medicare claims system data warehouse by February 25, 2011, to be included in the analysis. Claims for services furnished toward the end of the reporting period should be filed promptly. Claims that are resubmitted only to add the quality data codes will not be included in the analysis.
An example of reporting the eRx measure on a CMS-1500 claim form is shown below:
Qualified Registry
Eligible professionals may also qualify to earn an eRx incentive by reporting the eRx measure to a qualified registry. Professionals participating in a registry that self-
nominates and qualifies to submit data on behalf of eligible professionals for a particular program year should expect to receive more information from the registry on how to participate. Only registries qualified for the Physician Quality Reporting System
(Physician Quality Reporting) are eligible to become qualified for purposes of submitting data on the eRx measure on behalf of eligible professionals.
To qualify to submit eRx measure data on behalf of an eligible professional, the registry must be qualified to submit Physician Quality Reporting data. Registries are required to go through a self-nomination and vetting process if they are new to Physician Quality Reporting registry reporting or to notify CMS of their desire to continue Physician Quality Reporting data submission. To become qualified, registries must meet certain technical and other requirements specified by CMS.
Successful submission requires that the eRx measure results and data be sent by the registry to CMS in the specified format and includes all of the required information based on the reporting option.
CMS lists qualified registries on its Web site along with the steps to become a qualified eRx vendor of service. The information is found on the CMS Web site under the
Alternative Reporting Mechanism section at:
http://www.cms.gov/ERxIncentive/Downloads/Qualified_Registries_Phase4_eRxPQRI_0628 2010_FINAL.pdf
Detailed registry requirements as well as information on how to become a qualified registry can be found on the CMS Web site at the above link.
Providers must follow the eRx measure specifications as well as the applicable registry requirements. A combination of both requirements will be required in an effort to be successful in reporting through a qualified registry.
Qualified EHR
Beginning with 2010, eligible professionals may also qualify to earn an eRx incentive by submitting the eRx measure through a qualified EHR. CMS will accept the eRx data submitted by a qualified EHR vendor. After successful completion of the 2009 Physician Quality Reporting EHR testing and a determination that there was at least one
“qualified” EHR vendor, an eligible professional may potentially be able to earn an incentive payment through the EHR-based reporting mechanism.
An EHR vendor must be pre-approved and be deemed a “qualified” EHR vendor for an eligible provider to qualify. Previous qualified vendor lists are published on the CMS Web site, and CMS will publish additional information as vendors have been confirmed.
Information can be found on the CMS Web site at:
http://www.cms.gov/ERxIncentive/08_Alternative Reporting Mechanism.asp Additional information on EHRs can be found on the on the CMS Web site under the Alternative Reporting Mechanism section at:
http://www.cms.gov/ERxIncentive/Downloads/2011_EHR_eRx_Measure_Specs_and_Relea se_Notese_080910.zip
Submission through the EHR requires the eligible professional to utilize a qualified eRx system. It also requires all of the specified requirements within the measure be met when using the EHR.
Group Practice Reporting Option (GPRO)
January 1, 2010, CMS introduced a new reporting option for eRx, Group Practice
Reporting Option (GPRO). Group practices that are successful electronic prescribers for a particular reporting period are eligible to earn an eRx incentive payment equal to a specified percentage of the group practice’s total estimated Medicare Part B fee schedule allowed charges for covered professional services furnished during the reporting period. For 2011, the incentive payment is equal to 1 percent of the group practice’s total estimated Medicare Part B allowed charges for covered professional services furnished during the 2011 reporting period.
An individual eligible professional who is a member of a group practice selected to participate in the eRx GPRO is not eligible to separately earn an eRx incentive payment as an individual eligible professional under that same Tax Identification Number (TIN) (this is, for the same TIN/National Provider Identifier, or NPI, combination). Once a group practice (TIN) is selected to participate in GPRO, this is the only method of eRx reporting available to the group and all individual NPIs who bill Medicare under the group’s TIN.
Reporting Options
2011 GPROs are limited to group practices that selected participation in Physician Quality Reporting. The following reporting options are available for 2011:
Claims-based reporting.
Qualified registry-based submission.
Qualified EHR-based submission.
For 2011, providers may select from two GPROs:
GPRO I:
o Minimum group size of 200 or more eligible NPIs in the group.
GPRO II:
o Group size of two to 199 eligible NPIs in the group.
Definition of Group Practice Reporting Options
GPRO I
A physician group practice is defined by a single TIN, with at least 200 or more
individual eligible professionals (as identified by individual NPIs) who have reassigned their billing rights to the TIN.
GPRO II
A physician group practice is defined by a single TIN, with at least two to 199 individual eligible professionals (as identified by NPIs) who have reassigned their billing rights to the TIN.
To participate in the Physician Quality Reporting GPRO I or GPRO II, a group practice must submit a self-nomination letter to CMS and be selected to participate in the Physician Quality Reporting GPRO. Participation in the Physician Quality Reporting GPRO is required to participate in the eRx GPRO. Groups participating in the 2010 GPRO program will not need to submit another self-nomination letter; however, they must submit an e-mail to CMS to state they will continue 2011 participation.
Potential GPRO participants must comply with the definition of “group practice” as stated and must comply with the following requirements:
Meet the minimum requirements for a GPRO I or GPRO II eligible provider.
GPRO I participants may be required to validate the group’s NPIs using a list provided by CMS.
Must have billed Medicare Part B on or after January 1, 2010, and prior to October 29, 2010.
Agree to attend and participate in all mandatory training sessions.
Provide an electronic file (such as a Microsoft® Excel file) with the self-
nomination letter that includes the group practice’s TIN and the individual NPI numbers, name of the group practice and names of all eligible professionals who will be participating as part of the group practice (that is, all individual NPI
numbers, which are established Medicare providers and associated with a group practice’s TIN).
Provide a single point of contact for handling administrative issues as well as a single point of contact for technical support purposes.
Have technical capabilities, at a minimum: standard PC image with Microsoft® Office and Microsoft® Access software installed; and minimum software configurations.
Be able to comply with a secure method for data submission.
Provide CMS access (if requested) to review Medicare beneficiary data on which Physician Quality Reporting GPRO submissions are founded.
To be considered for GPRO Physician Quality Reporting (and eRx GPRO), group
practices must address the requirements in a self-nomination letter and send to CMS by January 31, 2011. The practices had to notify CMS of their desire to do so in the
nomination letter and meet all of the mandatory requirements. CMS evaluated the letters and made the decision to allow participation into one or both incentive programs if all requirements were met. CMS notified the practice if they met the requirements and were to be allowed participation under the new reporting.
GPRO Requirements for Submission of eRx Data
While participation in the eRx Incentive Program (either as an individual eligible
professional or under the eRx GPRO) is voluntary for group practices participating in the Physician Quality Reporting GPRO, CMS requires that for a group practice to
participate in the 2011 Physician Quality Reporting. A group practice must comply with all requirements for participation in the Physician Quality Reporting GPRO (I or II). A group practice that wishes to participate in both the Physician Quality Reporting GPRO and in the eRx GPRO must notify CMS of its desire to do so when self-nominating for the 2011 Physician Quality Reporting GPRO. The Physician Quality Reporting GPRO requirements and instructions for submitting the self-nomination letter can be found on the CMS eRx Web page under the Group Practice Reporting Option Downloads section at:
http://www.cms.gov/ERxIncentive/Downloads/2011_eRxforGPRO_MeasureSpecs_Releas eNotes111010.zip
Criteria for Determining Whether a Group Practice Is a Successful Electronic Prescriber Under 2011eRx GPRO
For purposes of determining whether a group practice is a successful electronic
prescriber, each group practice selected to participate in the eRx GPRO will be required
to report the eRx measure either through claims-based reporting, a qualified registry or a qualified EHR product. A list of qualified registries and EHR products for the eRx Incentive Program will be available on the CMS eRx Alternative Reporting Mechanism Web page at:
http://www.cms.gov/ERxIncentive/07_Group_Practice_Reporting_Option.asp#TopOfPage Specifications for the eRx measure for use in the eRx GPRO can be found on the CMS eRx Alternative Reporting Mechanism Web page under the Downloads section.
eRx Incentive Payment
If You Are a Successful E-Prescriber
During Calendar Year: Your Incentive Payment Is:
2009 2.0 percent
2010 2.0 percent
2011 1.0 percent
2012 1.0 percent
2013 .05 percent
You must submit claims no later than two months after the reporting period ends.
The Medicare eRx incentive payment will be made to the TIN established in the Provider Enrollment profile.
Lump-sum payment will be made either electronically or by check, based on how the TIN normally receives payment for Medicare-covered services.
In 2010 the Medicare Remittance Advice (MRA) glossary reflected a payment indicator of “LS” to clarify the type of incentive payment issued. The following example shows how a 2010 MRA would reflect the 2009 eRx incentive payment alongside the payment amount: LE RX09.
A feedback report can be obtained separately from the Medicare payment.
eRx Successful Reporting
The measure is intended to be reported for every patient visit in the denominator.
Successful reporting is defined as reporting the measure for at least 25 unique visits per year. The visit must be accompanied by the “G” code attesting that during the patient visit at least one prescription was electronically prescribed. An electronically generated prescription not associated with a denominator-eligible patient visit will not count toward the minimum of 25 different eRx events.
Limitation: 10 percent of an eligible professional’s Medicare Part B charges must include the codes in the denominator of the measure to be incentive-eligible.
10 Percent Examples
The following are examples of an eligible professional who has $100,000 in established allowed Medicare Part B charges.
Qualifies
$15,000 is based on the denominator codes.
$85,000 is procedure-related CPT/HCPCS codes.
Does Not Qualify
$5,000 is based on the denominator codes.
$95,000 is procedure-related CPT/HCPCS codes.
Future Penalties for Not Electronically Prescribing
A fee reduction is expected; providers will have to electronically prescribe by a date to ensure their fees are not reduced in 2012.
Eligible Professionals Who Are Not Successful Using eRx by 2012 If You Are Not an Electronic
Prescriber by: Physician Fee Schedule Reduction
2012 1.0 percent
2013 1.5 percent
2014 and beyond 2.0 percent
From 2012 through 2014, the payment adjustment will increase each calendar year. In 2012, the payment adjustment (reduction) will result in an eligible professional or group practice receiving a reduction in the physician fee schedule allowed amount.
Payment adjustments will not apply if 10 percent of an eligible professional’s (or group practice’s) allowed charges for the January 1, 2011 – June 30, 2011 reporting period comprises codes in the denominator of the 2011 measure.
Providers who do not have prescribing privileges, are in a rural area with limited Internet access, or have limited access to pharmacies with Internet capabilities should review the hardship HCPCS codes and submit the appropriate hardship code within the first six months of 2011 to prevent payment adjustments for the following year.
Additional information related to future penalties/payment adjustments can be found on the CMS Web site at:
http://www.cms.gov/ERxIncentive/downloads/2011eRxIncentiveProgramUpdatefor2012 PaymentAdjustment05-09-11.pdf
eRx Reporting Period
The reporting period for eRx is January 1, 2011 – December 31, 2011. Claims must be processed by Medicare and must reach the national Medicare claims system data warehouse by February 25, 2012, to be included in the analysis. Eligible professionals submitting claims for services furnished toward the end of the reporting period should file those claims promptly.
CMS will begin the process of calculating the claims that included eRx measures, calculation of data from qualified registries and/or EHR vendor profiles. CMS will notify Medicare contractors of all successful eligible professionals in late summer of 2012 when the bonus payments are expected to be paid.
eRx Feedback Reports
Each year the Physician Quality Reporting/eRx incentive payment and the feedback reports are issued. (These are handled through a separate process.) The feedback reports are issued whether an incentive payment was earned or not.
Reports are available for every TIN under which at least one eligible professional submitting Medicare Part B claims reported at least one valid eRx measure a minimum of once during the reporting period.
The reporting/analysis information can be found on the CMS Web Physician Quality Reporting Web site at:
http://www.cms.gov/PQRS//25_AnalysisAndPayment.asp Individual Eligible Professionals Feedback Reports
Beginning in 2009, providers can contact the Provider Contact Center (PCC) and request their individual feedback reports. This includes eligible professionals who are part of a group practice. The following information is required from the eligible
professional requesting the feedback reports:
Provider name.
Provider individual NPI.
Provider e-mail address.
Provider phone number.
Caller’s first and last name.
An e-mail will be sent to the eligible professional within 30 days of the request. If no report is available, a notification e-mail will be sent.
Group Practice Taxpayer Identification Number (TIN) Feedback Reports
TIN or group practice information reports still require access via the Physician Quality
Reporting Portal after first registering with IACS.
This alternative process will be available back to the 2009 Physician Quality Reporting and eRx feedback reports.
Note: Both Physician Quality Reporting and eRx reports are obtained through the same Web site portal, QualityNet.
Original/Group TIN Process
There is no registration deadline but before reports can be accessed, registration must be completed as follows:
IACS registration.
Request access to Physician Quality Reporting application via IACS.
Enter the Physician Quality Reporting application.
Note: If the professional has successfully registered with IACS, it is not necessary to register again; however, professionals must keep their password current. Users must change their IACS password every 60 days.
To view the feedback report, providers must have an approved enrollment record in CMS’ national provider enrollment system, known as the Provider Enrollment, Chain and Ownership System (PECOS).
The Medicare enrollment application (CMS-855I or the Internet-based PECOS enrollment application) must be completed to obtain the feedback report if:
No claims have been billed to the Medicare program in more than a year.
Or,
Enrollment records have not been updated with the designated Medicare contractor since November 2003.
You will not be able to view your feedback report until the Medicare contractor reviews and approves your Medicare enrollment application.
For additional information regarding the Medicare enrollment process, including Internet-based PECOS, go to:
http://www.cms.gov/MedicareProviderSupEnroll/
CMS also provides a Physician Quality Reporting Portal User Guide to assist with the Physician Quality Reporting Portal. The user guide can be found on the CMS Web site at:
http://www.cms.gov/PQRS//Downloads/PUG_PQRIPortalUserGuide.pdf
IACS Information and Steps to Accessing Feedback Reports
Step-by-step instructions to access feedback reports are found in the following CMS MLN Matters® articles:
SE 0747 – “Individuals Authorized Access to CMS Computer Services (IACS) – Provider/Supplier Community (IACS-PC): The First in a Series of Articles.”
SE 0753 – “Individuals Authorized Access to CMS Computer Services (IACS) – Provider/Supplier Community (IACS-PC): The Second in a Series of Articles.”
SE 0754 – “Individuals Authorized Access to CMS Computer Services (IACS) – Provider/Supplier Community (IACS-PC): The Third in a Series of Articles.”
For assistance, contact the QualityNet Help Desk at:
Telephone: (866) 288-8912
(877) 715-6222 – TTY/TDD
Monday – Friday, 7 a.m. – 7 p.m. CT
E-mail: [email protected]
Effective November 15, 2010, all IACS issues for Physician Quality Reporting should go through the QualityNet Help Desk. QualityNet can assist with registration, accessing the IACS account and changing the IACS account.
Reminder: The QualityNet Help Desk can assist callers in understanding the feedback reports as well as in understanding a particular measure.
Obtaining Feedback Reports
To verify that a feedback report is available, providers can search the QualityNet Web site at: https://www.qualitynet.org/portal/server.pt/community/pqri_home/212.
An example of the QualityNet Web site search is shown below:
The user should enter the tax ID of the eligible professional under TIN and select Lookup. If a report is available, the search box will return the message, “A report is available for the TIN XXXXX.”
Providers can log in to the QualityNet Web site to verify if a feedback report is available before registration steps are taken through the IACS Web site. To verify if a feedback report exists:
Log in to the QualityNet Web site at:
https://www.qualitynet.org/portal/server.pt/community/pqri_home/212.
Providers are not required to have an existing account or be a member to verify if a report is available.
Enter the TIN or NPI of the eligible professional in the lower left corner and select Lookup. Be sure to indicate the TIN or NPI in the selection field above the
number entered to allow a proper search of the reports.
A return search of “No report is available for the TIN/NPI xxxxx1111” indicates there is no Physician Quality Reporting quality feedback report available for the requested provider. A report will be available for any provider that filed at least one claim with a Physician Quality Reporting measure. Providers can call the Provider Contact Center or the QualityNet Help Desk for further assistance.
A return search of “A report is available for the TIN/NPI xxxxx1111” indicates there is a Physician Quality Reporting quality feedback report available. Log in to the IACS Web site and complete the registration process. Once IACS registration is complete, return to the QualityNet Web site to retrieve the quality feedback report(s).
Additional eRx Online Resources
The following online resources are also available on the CMS eRx Web site:
eRx Incentive Program Web site:
http://www.cms.gov/erxincentive/01_overview.asp
eRx Incentive Eligible Professionals:
http://www.cms.gov/ERxIncentive/05_Eligible Professionals.asp#TopOfPage
eRx Incentive Measure:
http://www.cms.gov/ERxIncentive/06_E-Prescribing_Measure.asp#TopOfPage
eRx Incentive Group Practice Reporting Requirements:
http://www.cms.gov/ERxIncentive/07_Group_Practice_Reporting_Option.asp#To pOfPage
eRx Incentive Alternative Reporting (Registry-Based Information, Electronic Health Record-Reporting Guidelines):
http://www.cms.gov/ERxIncentive/08_Alternative Reporting Mechanism.asp#TopOfPage
eRx Educational Resources:
http://www.cms.gov/ERxIncentive/09_Educational_Resources.asp#TopOfPage
eRx Help Desk/Support:
http://www.cms.gov/ERxIncentive/11_HelpDeskSupport.asp#TopOfPage
Physician Quality Reporting Portal User Guide:
http://www.cms.gov/PQRS//Downloads/PUG_PQRIPortalUserGuide.pdf
REVISION HISTORY
Date Section Revision
E-Prescribing Background
Added additional description of the Patients and Providers Act of 2008 (MIPPA).
E-Prescribing Overview
Included 2010 updates to e-prescribing overview information.
Qualified e-
Prescribing System Requirements
Included a complete listing for 2010 system requirements.
Eligible Professionals This is new – added a complete listing of who is eligible to e-prescribe.
Measure Instructions Included the entire e-prescribing measure to detail all required data.
Medicare Claim Submission Requirements
Added new information to detail:
Claim submission instructions.
Example of an e-prescribing completed CMS-1500 claim form.
Qualified Registry Added new information to detail e-prescribing via a qualified registry.
Qualified Electronic Health Record (EHR)
Added new information to detail e-prescribing via an EHR.
Group Provider Reporting Option (GPRO)
Added new information to detail e-prescribing via GPRO.
E-Prescribing
Successful Reporting
Added change in the number of times the e- prescribing measure must be met to allow for successful reporting.
E-Prescribing Reporting Period
Added new information to outline the reporting periods for this measure.
E-Prescribing Feedback Reports
Included information on the feedback reports, registration and help desk contact information.
February 2010
E-Prescribing Online Resources
Updated CMS Web site links to current 2010 e- prescribing educational tools.
August 2010
Obtaining Feedback Reports
Added additional information relating to the feedback reports and QualityNet Web site.
Date Section Revision eRx Overview Updates added to overview:
Providers may participate in both eRx and Physician Quality Reporting.
System must be qualified.
Ten percent of covered services must be made up of code pairs in the measure.
2012 providers who are not successful will see a payment reduction.
Faxing a script does not meet the requirements.
Questions to Consider Added questions to consider when selecting an eRx system.
Measure Instructions Included excerpts from the eRx measure with educational references.
Hardship Codes Added new codes for 2011 for providers requesting a hardship due to inability to report eRx measure.
Medicare Part B Claim
Submission Included information that eligible providers must participate in first six months of 2011 or be subject to a payment reduction in 2012.
Included hardship information for 2011 billing.
Updated CMS-1500 claim form example on billing eRx.
Qualified EHR Updated EHR qualified vendor information and updated CMS Web site link.
Group Practice Reporting Option (GPRO)
Updated GRPO section to include GPRO I and GPRO II billing opportunities.
Updated GPRO CMS Web site link for additional information.
eRx Incentive Payment
Included LS payment indicator for MRA for eRx incentive payment reporting.
December 2010
Future Penalties for Not Electronically Prescribing
Added update for 2012–2014 payment
adjustment for those providers not participating in eRx incentive.
Date Section Revision eRx Feedback
Reports Updated feedback report section to reflect that all inquiries and reports should be directed through QualityNet.
Included link to Physician Quality Reporting Portal User Guide.
June 2011
Future Penalties for Not Electronically Prescribing
Updated the link to the CMS reference for 2011 eRx incentive program update for 2012 payment adjustment.
