E-prescribing Incentive Program

Key Elements of the 2012 proposed rule include:

• Modification of measure to allow EPs to use either a qualified e-prescribing system or certified HER system
• Criteria will parallel 2012 and 2013 i.e., 25 scripts per year using G8553
• Same CPT code set for reporting with Rxs
• Significant hardship exemptions.

Incentives and Adjustments:

As with the Physician Quality Reporting System (PQRS) program, CMS defines group practice as a single Tax Identification Number (TIN) with at least 25 or more EPs who have reassigned their Medicare billing rights to the TIN.

To participate in the E-prescribing Incentive Group Practice Reporting Option (GPRO), in the proposal CMS:

• Limits participation in the 2012 E-prescribing Incentive GPRO to only those group practices with 25 or more EPs (because of low participation in the GRPO – only 62 groups)
• Requires group practices to self-nominate to participate in the E-prescribing GPRO
• Proposes to notify a group practice of the selection decision with respect to participation in the E-prescribing GPRO during the first quarter of the year
• Will not include a group practice that is deemed to be participating in the PQRS, such as an Accountable Care Organization participating under the Medicare Shared Savings Program, in the E-prescribing Incentive Program
• Designates two different reporting periods: a six-month reporting period (between Jan. 1, 2012 and June 30, 2012) for purposes of the 2013 payment adjustment for both individual EPs and group practices participating in the E-prescribing GPRO and a 12-month reporting period (between Jan. 1, 2011 and Dec. 31, 2011) for purposes of the 2013 payment adjustment for individual EPs and group practices participating in the E-prescribing Incentive GPRO