WHAT DO PROVIDERS NEED TO DO?

Providers must be using a “qualified” or “certified” e-Prescribing software as defined by CMS or the CMS EHR Incentive Program. A CMS “qualified” product is defined as one that maintains a complete Active Medications List, allows for the print or electronic transmission of prescriptions, has Drug and Allergy Interactions and Warnings, features Patient Prescription Plan Eligibility and has Formulary, Generic Alternative and Prior Authorization information. A “certified” product is a product that is ONC-ATCB certified for the CMS EHR Incentive Program.

Payment adjustments will automatically go into effect beginning January 1, 2012 for services performed in 2012. Existing e-Prescribers will not incur 2012 payment reductions if participating in the program according to 2011 program requirements. To avoid payment ajdustments in 2012, providers need to have submitted 10 G-codes prior to June 30, 2011. Payment reductions for 2013 will not be incurred with the submission of 25 total G-codes by the end of 2011 (including the 10 G-codes that needed to be submitted by June 30, 2011.

Providers are required to submit designated G-code for appropriate claims (below) that had electronically prescribed prescriptions (G8553). The following are specific visit codes that represent the appropriate claims:

Appropriate claims for submission of designated G-code to meet eRx Incentive Program requirements
90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 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

For detailed information on program requirements, click here to access the CMS eRx Incentive Program website.