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E-Prescribing Program

NOTE: E-Prescribing program retired effective Jan. 1, 2014. Physicians are no longer required to report G8553 on their claims.


2014 eRx Payment Adjustment Informal Review is Available Until Feb. 28, 2014

Are You Subject to the 2014 eRx Payment Adjustment?

Eligible professionals (EPs) and group practices (who self-nominated for the 2012 and/or 2013 Electronic Prescribing (eRx) group practice reporting option (GPRO)) who were not successful electronic prescribers under the eRx Incentive Program will be subject to a payment adjustment in 2014 as mandated by section 1848 (a)(5) of the Social Security Act.

All EPs and group practices had the opportunity to avoid the 2014 eRx payment adjustment through the following options:

  • Meeting the criteria for becoming a successful electronic prescriber
  • Requesting a hardship exemption or reporting a lack of prescribing privileges, or
  • Registering for participation or attesting to achieving Meaningful Use for the EHR Incentive Program

Complete information about the eRx payment adjustment is available on the eRx Payment Adjustment Information web page.

CMS will notify those EPs and group practices who will be subject to the 2014 eRx payment adjustment. Providers receiving the 2014 eRx payment adjustment will see the indicator β€œLE” on their Remittance Advice for all Medicare Part B services rendered from Jan. 1 through Dec. 31, 2014. The remittance advice will also contain the following Claim Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC):

  • CARC 237 – Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the National Council for Prescription Drug Programs (NCPDP) Reject Reason Code, or RARC that is not an ALERT).
  • RARC N545 – Payment reduced based on status as an unsuccessful electronic prescriber per the eRx Incentive Program.

Need to Request an Informal Review?

CMS has implemented an informal review process for the 2014 eRx payment adjustment. This means that EPs and group practices can request to have their applicable eRx Incentive Program reporting performance reviewed. Informal review requests will be accepted Nov. 1, 2013 through Feb. 28, 2014. EPs and group practices should submit their eRx informal review request via email to the informal review mailbox at eRxInformalReview@cms.hhs.gov. Complete instructions on how to request an informal review are available in the 2014 eRx Payment Adjustment Informal Review Made Simple educational document.


Need More Information?

The following CMS resources are available to help EPs and group practices access and understand their 2014 eRx payment adjustment and request an informal review:


Questions?

For all other questions related to the eRx Incentive Program, please contact the QualityNet Help Desk at 866.288.8912 (TTY 1.877.715.6222) or via qnetsupport@sdps.org, Monday through Friday from 7 a.m. to 7 p.m. CT.