Alternative Reporting Mechanism

Eligible professionals do not have to enroll or file an intent to participate in the eRx Incentive Program. Professionals who choose to participate by reporting the eRx measure through claims can simply report the G-code on service lines of Medicare Part B Physician Fee Schedule (PFS) professional-services claims.

Beginning with the 2010 eRx Incentive program year, 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 are eligible to become qualified for purposes of submitting data on the eRx measure on behalf of eligible professionals.

In addition to the claims-based reporting mechanism and the registry-based reporting mechanism, CMS  tested electronic health record (EHR) data submission, in cooperation with EHR vendors. After successful completion of the 2009 Physician Quality Reporting System EHR Testing Program and a determination that there was at least one "qualified" EHR vendor, an eligible professional may potentially be able to earn an eRx incentive payment through the EHR-based reporting mechanism beginning with the 2010 eRx Incentive Program (if the eligible professional is using one of the EHR products that CMS "qualified" in its 2009 Physician Quality Reporting System EHR Testing Program). Only an EHR vendor that is qualified for the Physician Quality Reporting System is eligible to become qualified for purposes of an eligible professional being able to earn an eRx incentive through submission of eRx measure data extracted from a qualified EHR product. 

2013 eRx Incentive Program

EHR-Based Submission for 2013 Incentive

In the 2013 proposed PFS rule (to be available July, 2012), CMS may propose that the 2013 EHR measure specification for the eRx Incentive Program may be available for EHR-based reporting in 2013.

The "DRAFT 2013 EHR Measure Specifications for eRx" and the corresponding "DRAFT 2013 EHR Measure Specifications for eRx - Release Notes" documents may be found in the "Downloads" section below. The specifications contain a detailed description of data element names and codes. Additionally, the "DRAFT 2013 EHR Downloadable Resource Table" and the corresponding "DRAFT 2013 EHR Downloadable Resource Table - Release Notes" may be found in the "Downloads" section below. Vendors should refer to the "EHR Documents for Vendors" in the "Downloads" section on the "Alternative Reporting Mechanism" page on the Physician Quality Reporting System website.

To qualify to report the eRx measure for 2013, EHR Direct vendors will need to be qualified to report 2013 Physician Quality Reporting System EHR measures. The self-nomination and vetting process for EHR Direct for 2013 Physician Quality Reporting System will occur in 2012. EHR Direct Vendors who wish to become qualified to participate in 2013 Physician Quality Reporting System should have submitted a self-nomination letter via mail to CMS no later than March 2, 2012. More details regarding the 2013 Physician Quality Reporting System EHR Direct Vendor qualification process and requirements for the 2013 Physician Quality Reporting System EHR Testing Process are described in the "Qualification Criteria for Electronic Health Record (EHR) Direct Vendors for the 2013 PHYSICIAN QUALITY REPORTING SYSTEM ," which is available in the "Downloads" section under “2013 EHR Direct Vendor Qualification Criteria” on the “Alternative Reporting Mechanism” page on the Physician Quality Reporting System website.

2012 eRx Incentive Program

2012 EHR Direct Vendor Qualified Posting

CMS is pleased to announce the EHR Direct vendors and their system and products (including specific version or release) that have been “qualified” to submit quality data to CMS by eligible professionals for the 2012 Physician Quality Reporting System program year. Each of these EHR Direct vendors has completed a thorough vetting process to verify that their system and product(s) has the capability to provide the required data elements for the 51 Physician Quality Reporting System EHR measures.  See the table and more information in the document titled “2012 EHR Direct Vendor Qualified Posting” in the “Downloads” section below.

2012 EHR Data Submission Vendor Qualified Posting

CMS is pleased to announce the EHR Data Submission vendors that have been “qualified” to submit quality data to CMS by eligible professionals for the 2012 Physician Quality Reporting System program year. Each of these EHR Data Submission Vendors has completed a thorough vetting process to verify they have the capability to provide the required data elements for the measures they intend to submit.  Some EHR Data Submission Vendors are also capable of reporting the electronic prescribing (eRx) measure to CMS. See the table and more information in the document titled "2012 EHR Data Submission Vendor Qualified Posting" in the "Downloads" section below.

2012 Phase 2 Registry Qualified Posting

CMS is pleased to announce the registries that have successfully "qualified" to submit quality data to CMS on behalf of their eligible professionals for 2012 PQRS reporting. Each of these registries have completed the vetting process which includes providing the required PQRS data elements in an xml file submission, reviewing a measure flow and algorithms, performing use case calculations (this checks to see whether the registry calculates the measure's reporting and performance rates correctly). Some registries are also capable of reporting the electronic prescribing measure to CMS. See the table and more information in the document titled "2012 Phase 2 Registry Qualified Posting" in the "Downloads" section below.

2012 eRx Incentive Program XML File Specification 

CMS has posted the 2012 eRx XML file specification.  This file can be viewed by clicking on the document titled "Electronic Prescribing Incentive Program XML File Specification for Program Year 2012" in the "Downloads" section below.   

EHR-Based Submission for 2012 Incentive

In the 2012 Final PFS rule, CMS stated that the 2012 EHR measure specification for the eRx Incentive Program will be available for EHR-based reporting in 2012.

The "2012 EHR Measure Specifications for eRx" and the corresponding "2012 EHR Measure Specifications for eRx - Release Notes" documents may be found in the "Downloads" section below in the "2012 EHR eRx Documents for Eligible Professionals" zip file. The specifications contain a detailed description of data element names and codes. Additionally, in this zip file, the "2012 EHR Downloadable Resource" and the corresponding "2012 EHR Downloadable Resource Table - Release Notes" may be found in the "Downloads" section below. Vendors should refer to the "EHR Documents for Vendors" in the "Downloads" section on the "Alternative Reporting Mechanism" page on the Physician Quality Reporting System website.

To qualify to report the eRx measure for 2012, EHR vendors will need to be qualified to report 2012 Physician Quality Reporting System EHR measures. EHR vendors who wish to qualify to participate in the 2012 Physician Quality Reporting System EHR program must have submitted a self-nomination letter requesting inclusion in the 2012 Physician Quality Reporting System Testing Process in 2012 by no later than January 31, 2011. The 2012 Physician Quality Reporting System EHR vendor qualification process and requirements for the 2011 Physician Quality Reporting System EHR Testing Process are described in the "Requirements for EHR Vendors to Participate in the 2012 Physician Quality Reporting System EHR Program," which is available in the "Downloads" section below. Any EHR vendor that wants to report the eRx measure for the 2012 eRx Incentive Program also will need to have followed the requirements contained in this document.