E-Prescribing Incentive Program – Eligible professionals

Eligible professionals do not need to participate in the Physician Quality Reporting System to participate in the Electronic Prescribing (eRx) Incentive Program.

Under the eRx Incentive Program, covered professional services are those paid under the Medicare Physician Fee Schedule (PFS). To the extent that eligible professionals are providing services which are paid under the PFS, those services are eligible for eRx Incentive Program.

Eligible and Able to Participate

The following professionals are eligible to participate in eRx Incentive Program: Eligible professionals must have prescribing authority in order to participate in this program.

1. 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

2. Practitioner

• Physician Assistant

• Nurse Practitioner

• Clinical Nurse Specialist

• Certified Registered Nurse Anesthetist (and Anesthesiologist Assistant)

• Certified Nurse Midwife

• Clinical Social Worker

• Clinical Psychologist

• Registered Dietician

• Nutrition Professional

• Audiologists

3. Therapists

• Physical Therapist

• Occupational Therapist

• Qualified Speech-Language Therapist

Eligible But Not Able to Participate

The following professionals are eligible to participate but are not able to participate for one or more reasons:

1. Professionals paid under or based upon the PFS billing Medicare Carriers/ Medicare Administrative Contractors (MACs) who do not bill directly.

2. Professionals paid under the PFS billing Medicare fiscal intermediaries (FIs) or MACs. The FI/MAC claims processing systems currently cannot accommodate billing at the individual physician or practitioner level:

• Critical access hospital (CAH), method II payment, where the physician or practitioner has reassigned his or her benefits to the CAH. In this situation, the CAH bills the regular FI for the professional services provided by the physician or practitioner.

• All institutional providers that bill for outpatient therapy provided by physical and occupational therapists and speech language pathologists (for example, hospital, skilled nursing facility Part B, home health agency, comprehensive outpatient rehabilitation facility, or outpatient rehabilitation facility). This does not apply to skilled nursing facilities under Part A.

Services payable under fee schedules or methodologies other than the PFS are not included in Physician Quality Reporting (for example, services provided in federally qualified health centers, independent diagnostic testing facilities, independent laboratories, hospitals [including method I critical access hospitals], rural health clinics, ambulance providers, and ambulatory surgery center facilities).

Eligible professionals participating in the eRx Incentive Program should familiarize themselves and their office staff with the eRx Incentive Program requirements for the relevant program year.