2009 Electronic Prescribing (eRx) Incentive Program Update, Feedback Reports

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce important information about accessing 2009 Electronic Prescribing (eRx) Incentive Program feedback reports is posted to the eRx webpage at http://www.cms.gov/ERXincentive on the CMS website.

The 2009 eRx Incentive Program feedback reports will be available in November 2010 after the 2009 eRx incentive payments are distributed. Feedback reports are compiled at the Taxpayer Identification Number (Tax ID Number, or TIN) level, with individual-level reporting (by National Provider Identifier or NPI level) information for each Eligible Professional (EP) who reported at least one valid eRx quality-data code (QDC) on a claim submitted under that TIN for services furnished during the reporting period.

Several new and updated educational resource documents about accessing 2009 Electronic Prescribing (eRx) Incentive Program feedback reports are now available on the “Spotlight, 2009 PQRI Program and eRx Overview” links of the eRx website and include the following:

• A downloadable WORD document on accessing 2009 eRx Incentive Program Feedback Reports.
• 2009 PQRI Feedback Report User Guide
• 2009 eRx Feedback Report User Guide
• A Guide for Understanding 2009 PQRI Incentive Payment

2010 Electronic Prescribing (eRx) Incentive Program Participation Reminder

It’s not too late to start participating in the 2010 Electronic Prescribing (eRx) Incentive Program and potentially qualify to receive a full-year incentive payment. Eligible professionals (EPs) may begin reporting eRx at any time throughout the 2010 program year of January 1-December 31, 2010 to be incentive-eligible.

The Electronic Prescribing Incentive Program is a separate incentive program from the Physician Quality Reporting Initiative (PQRI), with different reporting requirements. To successfully meet reporting criteria and be considered incentive eligible, individual EPs must report the eRx measure at least 25 times (for eligible patient encounters) and the Medicare Part B Physician Fee Schedule (PFS) allowed charges for services in the eRx measure’s denominator should be comprised of 10% or more of the EP’s total 2010 estimated allowed charges.

For 2010, eligible professionals who successfully report the eRx measure will become eligible to receive an eRx incentive equal to 2.0% of their total Medicare Part B Physician Fee Schedule (PFS) allowed charges for services performed during the reporting period. Eligible professionals must have adopted a “qualified” eRx system. There are two types of systems: a system for eRx only (stand-alone) or an electronic health record (EHR system) with eRx functionality. Regardless of the type of system used, to be considered “qualified” it must be based on ALL of the following capabilities:

§ Generating a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers (PBMs) if available

§ Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all alerts

§ Providing information related to lower cost, therapeutically appropriate alternatives (if any). (The availability of an eRx system to receive tiered formulary information, if available, would meet this requirement for 2010)

§ Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan, if available.

If you have not yet participated in the eRx program, you can begin by reporting eRx data for January 1-December 31, 2010 using any of the following three options:

§ Claims-based reporting of the eRx measure. Report only one G-code (G8553) for 2010

§ Registry-based reporting using a CMS-selected *registry, submitting 2010 data to CMS during the first quarter of 2011

§ EHR-based reporting using a CMS-selected *electronic health record product, submitting 2010 data to CMS during the first quarter of 2011

*Only registries and EHR vendors who have been selected by CMS for the 2010 PQRI/eRx and are on the posted list of registries/EHR vendors are eligible to be considered “qualified” for purposes of the 2010 Electronic Prescribing Incentive Program (visit http://www.cms.gov/ERxIncentive/08_AlternativeReportingMechanism.asp on the CMS website).

Claims-based reporting involves the addition of a quality-data code (QDC) to claims submitted for services (occurring during the reporting period) when billing Medicare Part B. EPs also have the option of using a qualified registry to assist in collecting eRx measure data. The registry will submit this quality data directly to Medicare, eliminating the need for adding the QDC to the Medicare Part B claim.

Eligible professionals do not need to sign up or pre-register to participate in the 2010 eRx. Reporting one QDC (G8553) for the eRx measure to CMS through claims, or submission via a qualified registry or a qualified EHR will indicate intent to participate.

Although there is no requirement to register prior to submitting the data, EPs should review the educational products CMS has created on how to get started with eRx reporting. To access all available educational resources on eRx please visit http://www.cms.gov/eRxIncentive/on the CMS website. Eligible professionals are encouraged to check the eRx webpage often for the latest information and downloads.

Additional Resources:

§ 2010 eRx Measure Specification and Release Notes (EPs should the eRx measure specification documents for the current program year. Refer to the specification for the reporting method applicable to your practice):

o Claims- and registry-based at http://www.cms.gov/ERxIncentive/Downloads/2010_eRx_MeasureSpecificationsandReleaseNotes_121709.zip

o EHR-based at http://www.cms.gov/ERxIncentive/Downloads/2010EHRMeasureSpecificationforeRxandReleaseNotes.zip

§ Claims-Based Reporting Principles for Electronic Prescribing (eRx) Incentive Program at http://www.cms.gov/ERxIncentive/Downloads/Claims-BasedReportingPrinciplesforeRx122209.pdf

§ 2010 eRx Incentive Program Made Simple Fact Sheet at http://www.cms.gov/ERxIncentive/Downloads/2010eRxMadeSimpleFS032310f.pdf

§ 2010 eRx Incentive Program Fact Sheet: What's New for 2010 eRx Incentive Program at http://www.cms.gov/ERxIncentive/Downloads/WhatsNew2010eRxFS032310f.pdf

Questions? If you have questions on how to get started with eRx, please contact the QualityNet Help Desk at 866-288-8912 (from 7am-7pm CST) or via e-mail at qnetsupport@sdps.org.