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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:
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 “LE” 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):
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.
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:
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 firstname.lastname@example.org, Monday through Friday from 7 a.m. to 7 p.m. CT.
In order to receive 2013 incentive payment of 0.5 percent of all Medicare Part B, Medicare as a secondary payer and Railroad Medicare, less durable medical equipment or any drug injected, HCPCS code G8553 must be billed in association with an exam a minimum of 25 times with dates of service between Jan. 1 and Dec. 31, 2013.
Be sure to confirm that G8553 was successfully received by verifying the remittance advice codes N365 and/or CO93.
Remember that if the exam is denied, G8553 is denied too and must be submitted again on the corrected resubmitted claim.
Practices who report successfully will receive an incentive payment in the fall of 2014. The check will be sent to the group practice TIN number. In order to receive a report indicating the percentage of dollars achieved by each physician of the practice, contact QualityNet Help Desk:
In order to avoid the payment adjustment practices had to e-prescribe at least 10 times between Jan. 1 and June 30, 2013 dates of service by submitting HCPCS code G8553 along with any billable service. The billable service could be an exam, a test, or a surgical procedure. Reporting must be from your office — not through a registry.
NOTE: Any item carried by a pharmacy can be e-prescribed.
E-Prescribing may be reported through a qualified CMS registry. The Academy has partnered with Outcome Registry. To contact Outcome for PQRS or E-Prescribing assistance: