2013 ERx Measure Specifications
Like previous years we need to report E-Prescription measures on atleast 10 claims for the reporting period January 1 through June 30, 2013 and atleast 25 claims (including the 10 claims) for the reporting period Jan 1 through December 31, 2013 inorder to receive ERx incentive payments. ERx measures if reported via claims the HCPCS code G8553 that denotes “At least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system (not faxed from the eligible professional’s office)” should always be submitted along with any of the applicable visit codes (Denominators) listed below on the same claim.
Denominator codes:
90791, 90792, 90832, 90834, 90837, 90839, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109
Please note:
ERx datas must be processed into the NCH (National Claims History database) no later than July 26, 2013
The eRx G-code can be reported on any Medicare Part B claim that includes a billable Part B service, regardless of whether the claim contains coding in the eRx measure’s denominator.
Eligible professionals who haven’t met the ERx requirements (Reporting G8553 at least 25 times along with the above listed codes for the period from Jan 1 through December 31, 2012) can still request for an Hardship exemption till January 31, 2013 at the given below link
https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234
Eligible professionals who doesn’t meet the ERx requirement may end up with penalty of 1.5% adjustment in 2013 (eligible professional will receive 98.5% of their Medicare Part B PFS amount for covered professional services); and 2.0% adjustment in 2014 (eligible professional will receive 98% of their Medicare Part B PFS amount for covered professional services). Eligible Professionals list: http://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive/Eligible-Professionals.html
Claims may NOT be resubmitted for the sole purpose of adding or correcting the G-code.
The ERx measure specification for the year 2013 has also been attached herewith for your review. Please communicate all of these to our Clients and encourage them for E-prescribing programs.
