Incentive Payments

Eligible professionals who participate in the Electronic Prescribing (eRx) Incentive Program by reporting on their adoption and use of a qualified eRx system that has the functionalities required by CMS may qualify for an incentive payment.

Electronic prescribing is the transmission of prescription or prescription-related information through electronic media. The Medicare Improvements for Patients and Providers Act of 2008 (known as MIPPA) authorized the Medicare Electronic Prescribing Incentive Program to promote adoption and use of electronic-prescribing systems. With eRx, health care professionals can electronically transmit both new prescriptions and responses to renewal requests to a pharmacy without having to write or fax the prescription.

The eRx incentive payment is similar to the Physician Quality Reporting Initiative, or PQRI incentive in that it is based on the Medicare Part B Physician Fee Schedule (PFS) covered professional services furnished by the eligible professional during a reporting period. To be eligible for the incentive, you must meet the criteria for being a successful electronic prescriber. The criteria used to determine whether an eligible professional is a successful electronic prescriber are established for each program year through rulemaking.

Below are the authorized incentive payment amounts for each program year:

• 2009 eRx – 2.0%; and

• 2010 eRx – 2.0%.

Incentive payments for each program year are issued separately as a single consolidated incentive payment in the following year. Incentive payments are issued to the first valid group location listed under the Taxpayer Identification Number (TIN); or, for solo practitioners, to the first valid practice location listed under the TIN. The Carrier/MAC will make the payment electronically or via check, based on how the TIN normally receives payment for Medicare Part B PFS covered professional services furnished to Medicare beneficiaries. If a TIN submits claims to multiple Medicare claims-processing contractors (Carriers or MACs), each contractor may be responsible for a proportion of the TIN incentive payment equivalent to the proportion of Medicare Part B PFS claims the contractor processed during the applicable reporting period. (Note: If splitting an incentive across contractors would result in any contractor issuing an eRx incentive payment less than $20 to the TIN, the incentive will be issued by fewer contractors than may have processed PFS from the TIN for the reporting period). The eRx incentive payment can be offset by an outstanding debt for the TIN.

The incentive payment, with the remittance advice, will be issued by Carrier/MAC and identified as a lump-sum eRx incentive payment. Effective January 2010, CMS revised the manner in which incentive payment information is communicated to eligible professionals receiving electronic remittance advices. CMS has instructed Medicare contractors to use a new indicator of LE to indicate incentive payments instead of LS. LE will appear on the electronic remit. In an effort to further clarify the type of incentive payment issued (either PQRI or eRx incentive), CMS created a 4-digit code to indicate the type of incentive and reporting year. For the 2009 eRx incentive payments, the 4-digit code is RX09. This code will be displayed on the electronic remittance advice along with the LE indicator. For example, eligible professionals will see the LE to indicate an incentive payment, along with RX09 to identify that payment as the 2009 eRx incentive payment. Additionally, the paper remittance advice will read, “This is an ERx incentive payment.” The year will not be included in the paper remittance.

Once we begin distributing incentive payments for a particular program year and your lump-sum incentive does not arrive or the incentive payment amount does not match what is reflected in your eRx Incentive Program feedback report, contact your Carrier/MAC (click on the “Help Desk Support” link at left for contact information). Note: The incentive amount may differ by a penny or two from what is reflected in your feedback report due to rounding.

eRx Incentive Program Feedback Reports

The eRx incentive payments and the eRx feedback reports are issued through separate processes (click on the appropriate “eRx Program” link at left for information specific to a particular program year). eRx Incentive Program feedback report availability is not based on whether or not an incentive payment was earned. Feedback reports will be available for every TIN under which at least one eligible professional (identified by his or her National Provider Identifier, or NPI) submitting Medicare Part B PFS claims reported the eRx measure a minimum of once during the reporting period.