Analysis and Payment

Each year, the Electronic Prescribing (eRx) Incentive Program incentive payment and the eRx Incentive Program feedback report are issued through separate processes. 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 at least one valid eRx Incentive Program measure a minimum of once during the reporting period. ERx Incentive Program participants will not receive claim-level details in the feedback reports.

Incentive Payments

Eligible professionals who participate in the 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.

MIPPA authorized incentive payments through 2013. Below are the authorized amounts for each program year:

• 2009 eRx – 2.0%
• 2010 eRx – 2.0%
• 2011 eRx – 1.0%
• 2012 eRx – 1.0%
• 2013 eRx – 0.5% (last year for eRx incentive payment)

Please note that the Medicare Improvements for Patients and Providers Act of 2008 (known as MIPPA) also requires CMS to subject eligible professionals who are not successful electronic prescribers to a payment adjustment beginning in 2012 through 2014. Additional information can be found on the “Payment Adjustment Information” page located to the left.

The eRx incentive payment is similar to the Physician Quality Reporting System 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.

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 Medicare claims-processing contractors (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 Carriers/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 separate payment under the eRx Incentive Program. Medicare contractors will use the indicator of LE (“Levy”) to indicate federally mandated payments. LE will appear in the PLB-03-1 segment of the 835. In an effort to further clarify the type of incentive payment issued LE will appear on the remit, along with a 4-digit code to indicate the type of incentive and reporting year.

For example, eligible professionals will see the LE to indicate an incentive payment, along with RX10 to identify that payment as the 2010 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 if your 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.

2011 eRx Incentive Program

A Guide for Understanding the 2011 Electronic Prescribing (eRx) Incentive Program Incentive Payment

This document describes how the 2011 Electronic Prescribing (eRx) Incentive Program incentive payment was calculated for 1) individual eligible professionals, and 2) self-nominated and CMS-selected eRx Group Practice Reporting Option (GPRO) participants.

2011 Electronic Prescribing (eRx) Incentive Program Feedback Report User Guide

The Electronic Prescribing (eRx) Incentive Program Feedback Report User Guide is designed to assist eligible professionals, CMS-selected group practices, and their authorized users in accessing and interpreting the 2011 eRx Incentive Program feedback reports.

Location of Previous Program Year Documents

All previous program year documents will be moved from this page to that specific program year section page at left.