Federal government's eRx incentive program criteria unambiguous

February 1, 2012

In 2009, the federal government launched its Electronic Prescribing (eRx) Incentive Program. Although this program (which was authorized in the Medicare Improvements for Patients and Providers Act of 2008/MIPPA) is now three years old, physicians remain confused about the details. Fortunately, the eRx Incentive Program is straightforward.

Key Points

Much of the confusion is the result of the "government incentive program overload" providers are facing. Fortunately, the eRx Incentive Program is straightforward. Unlike the government's other major incentive programs, the eRx qualification criteria are unambiguous: If you qualify for the program, you must submit a code to indicate that you electronically prescribed during 25 unique visits with a Medicare patient, and the bonus is yours.

With this incentive about to sunset and the penalties now being applied to providers who could qualify but decided not to participate, now is an opportune time to get the facts about the program.

Why go to the trouble? Let's say a dermatologist receives $650,000 a year in revenue. If 22 percent of her payer mix is Medicare Part B, she receives a total of $143,000 from Medicare. The eRx program offers a 1 percent bonus - $1,430 in the case of our sample dermatologist. Although that return may not be huge, consider that the only requirement to get it is to generate and report an eRx event associated with 25 unique Medicare patient visits. Because this functionality is built into electronic health record systems (EHRs) and there also is a free, qualified system readily available for use from the National ePrescribing Patient Safety Initiative (NEPSI, http://www.nationalerx.com/), the extra effort needed to get this money is minimal and well worth it.

G8553 is defined by CMS as "at least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system."

The program does not consider faxing a qualifying electronic transmission, but if you have an EHR (especially one certified for the EHR Incentive Program by the Office of the National Coordinator for Healthcare Information Technology), eRx functionality is a part of the system. You also can use a standalone e-prescribing system like the one available at no cost through NEPSI.