Reminder to Participate in CMS Incentive Programs

January 23, 2012 – A new year to report PQRS and eRx measures began January 1, 2012.  If you have not yet chosen to participate in these programs and want to earn incentives or avoid a payment reduction, you must begin participation as soon as possible.

eRx (e-prescribe) Program
 
Not participating in this program in 2012 may result in a 2% payment reduction of your 2014 Medicare payments. To prevent this reduction, you must report the eRx measure code (G8553), along with a qualified denominator code (CPT code) at least 25 times for the year 2012.
 
Another Chance to Avoid the 2013 Payment Penalty – CMS is giving eligible providers another chance to avoid the 2013 payment adjustment of 1.5%.  If you did not qualify last year by submitting the required 25 e-prescribe encounters, you may still qualify by submitting 10 e-prescribe encounters via code G8553 for service dates between January 1, 2012– June 30, 2012.  This submission option does not need to be sent with a denominator code.  As long as you send your prescription on a qualified e-prescribe system, you may submit the G8553 code alone.   This is beneficial to those providers who do not usually prescribe during one of the 56 eligible CPT code visits. 

The G8553 code must be reported via claims-based submission and must be processed by Medicare as of July 27, 2012.
 
PQRS Incentive Program

The sooner you begin, the greater chance you will have to meet the reporting requirements for participation in this program for calendar year 2012.  The incentive for this year’s submissions is 0.5% of your total Medicare allowable charges.
 
If you have not yet informed your Client Manager of your desire to participate in these programs, please do so as soon as possible and they can assist you in getting started.