Frequently Asked Questions

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FAQ

By Topic: Quality Initiatives/Patient Assessment Instruments Subtopic: E-Prescribing Incentive Program


Can eligible professionals (physicians and non-physicians) get paid a Physician Quality Reporting System in...
Medicare Advantage organization (MAO) payments to contracted providers are governed by the terms of the contract between... (more)

How will the 2014 Electronic Prescribing (eRx) payment adjustment apply to providers who do NOT participate...
Irrespective of whether an eligible professional is deemed Medicare participating (PAR) or non-participating (NON-PAR... (more)

Who should I contact if I have questions about the Physician Quality Reporting System (PQRS) or the Electro...
If you have questions, please contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or ... (more)

What type of electronic prescribing system must I have in order to participate in the Electronic Prescribin...
Eligible professionals must have adopted a "qualified" eRx system. A "qualified" eRx system is one that either has ALL o... (more)

Can Durable Medical Equipment supplies that are electronically prescribed be counted toward the eRx Incenti...
Yes, any and all Durable Medical Equipment, Prosthetic and Orthotic Supplies (DMEPOS) that can be transmitted electronic... (more)

Some pharmacies reject electronic prescription transmittals for diabetic testing supplies and require addit...
Yes. The eligible professional should transmit the prescription for diabetic testing supplies electronically using a qua... (more)

What are the reporting requirements for eligible professionals working under multiple Taxpayer Identificati...
Individual eligible professionals (identified on claims by their individual National Provider Identifier [NPI] and Ta... (more)

Where can I find a list of qualified registries and their associated costs for the Physician Quality Report...
We post a list of qualified registries on the CMS Physician Quality Reporting and eRx Incentive Program websites under t... (more)

How can I view my Physician Quality Reporting System or Electronic Prescribing Incentive Program feedback r...
If you do not have Microsoft® Office 2007, you can download the free Excel® Viewer or Compatibility Pack® from Microsoft... (more)

I am an eligible professional participating in the Physician Quality Reporting System and/or the Electronic...
Yes, “incident to” billing is included in the analysis of reporting for the Physician Quality Reporting System and/or... (more)

How are electronic prescription(s) counted when reporting for the Electronic Prescribing (eRx) Incentive Pr...
Instances of electronic prescribing on Medicare Part B PFS patient events are counted to determine successful reporting ... (more)

For a group practice with fewer than 200 individual eligible professionals in a single Taxpayer Identificat...
A group practice with 25-199 eligible professionals could self-nominate to participate in Physician Quality Reporting or... (more)

If an eligible professional does not report the required number of electronic prescriptions by June 30, 201...
An eligible professional may be subject to the 2014 eRx payment adjustment if (s)he does not prescribe and report a m... (more)

[eRx] Can I submit a significant electronic prescribing (eRx) hardship exemption request on behalf of a pro...
Yes, during the 2013 eRx program year you may submit the eRx hardship exemption request on behalf of your provider. B... (more)

Can eligible professionals participate in the 2013 Physician Quality Reporting System (PQRS), 2013 Electron...
PQRS, eRx Incentive Program, and EHR Incentive Program are three distinctly separate CMS programs. PQRS in... (more)

What is meant by "unique" patients or events in the Physician Quality Reporting System or the Electronic Pr...
The term "unique" is used differently in Physician Quality Reporting than in the eRx Incentive Program.For eligi... (more)

If a physician or other eligible professional who is participating in the Electronic Prescribing (eRx) Ince...
Only if the Locum Tenens is reporting using the original eligible professional's Taxpayer Identification Number/National... (more)

Will Physician Quality Reporting System (PQRS) or Electronic Prescribing (eRx) Incentive Program results be...
CMS will publish PQRS and eRx quality information such as participation and reporting rates. In addition, some aggregate... (more)

If a patient calls to refill a prescription or requests a new prescription and there is no associated offic...
No. To qualify for reporting the eRx measure, there must be a covered Medicare Physician Fee Schedule (PFS) service furn... (more)

How can I view my Physician Quality Reporting System (PQRS) or Electronic Prescribing (eRx) Incentive Progr...
If you do not have Microsoft® Office 2007, you can download the free Excel® Viewer or Compatibility Pack® from Micros... (more)

Can a physician or other eligible professional who is enrolled in Medicare, but has not signed the Particip...
Yes. Medicare-enrolled physicians and other eligible professionals who have not completed a Participation agreement, but... (more)

How will gaining or losing eligible professional(s) throughout the reporting period affect group practices ...
The group practice will be required to report the measures group(s), individual measures, and eRx events (if applicable)... (more)

If a resident electronically prescribes for a Medicare patient at an encounter, can the attending (teaching...
Yes, it would be appropriate for the teaching physician to submit G8553 for eRx on the claim IF all of the following app... (more)

Can eligible professionals participating in the Physician Quality Reporting System and the Electronic Presc...
If a patient has an allowable Medicare Physician Fee Schedule (PFS) Part B covered professional service, that meets the ... (more)

Should providers include the Physician Quality Reporting System and Electronic Prescribing Incentive Progra...
Providers should not include the Physician Quality Reporting or eRx Incentive Program QDCs on claims submitted to primar... (more)

Can an eligible professional participating in the Electronic Prescribing (eRx) Incentive Program report on ...
It is acceptable for the eligible professional to report G8553 if at least one prescription created during the encounter... (more)

How is the incentive payment calculated for an individual eligible professional who participates in the Ele...
CMS will review data submitted to determine successful reporting and eligibility for a maximum incentive payment (1% ... (more)

I want to participate in the Electronic Prescribing (eRx) Incentive Program 6-month reporting period to avo...
To avoid the 2013 eRx payment adjustment by participating in the 2012 eRx 6-month reporting period, eligible professiona... (more)

Will crossover claims sent from the Coordination of Benefits Contractor to trading partners include quality...
Yes. Crossover claims include all QDC line items for Physician Quality Reporting and eRx (for an amount of $0 or a nomin... (more)

How can I be sure that my claims software will be able to successfully include the individual National Prov...
To satisfactorily report quality-data codes, eligible professionals and/or their office staff should work with their sof... (more)

If an eligible professional participating in the Electronic Prescribing (eRx) Incentive Program completes a...
Yes, the eligible professional may report G8533 if at least one prescription created during the encounter was generated ... (more)

What should I do if codes were submitted in error for the Physician Quality Reporting System (PQRS) or the ...
If you or any other eligible professionals are in this situation, you should work with your respective Carriers or A/B M... (more)

If an eligible professional electronically prescribes over-the-counter (OTC) medicine, will this be counted...
If an eligible professional sends an eRx (via a qualified eRx system) to the pharmacy electronically (for a denominator-... (more)

Are exclusion modifiers (1P, 2P, 3P) and the 8P reporting modifier allowed or considered in the Electronic ...
Exclusion or reporting modifiers are not included in the 2013 eRx Incentive Program measure; therefore, modifiers report... (more)

Do practices need to have and use an electronic health record in order to participate in the Physician Qual...
No. Practices do not need electronic health records (EHR) to participate in Physician Quality Reporting or the eRx Incen... (more)

What should I do if codes were submitted in error for the Physician Quality Reporting System or the Electro...
If you or any other eligible professionals are in this situation, you should work with your respective Carriers or Medic... (more)

Why does it take six to eight months to receive incentive payments and feedback reports for the Physician Q...
The payments and feedback reports are dependent on the time it takes to process and analyze the data.We understa... (more)

Why is there so much "extra" information in my feedback report about what I "could have" done in the Physic...
Our feedback reports are packaged at the Taxpayer Identification Number (Tax ID Number, or TIN) level, with individual-l... (more)

If I am an eligible professional participating in the Physician Quality Reporting System Group Practice Rep...
You can participate in the eRx Incentive Program as a group practice participating in eRx GPRO. Group practices particip... (more)

Will each individual eligible professional OR selected group practice who participates in the Physician Qua...
Yes. CMS will provide confidential feedback reports mid-year, following the end of the Physician Quality Reporting and e... (more)

Does a Physician Quality Reporting System or Electronic Prescribing Incentive Program quality-data code on ...
Yes. Each claim detail line containing a Physician Quality Reporting/eRx QDC must be completed the same way as any ot... (more)

I was a successful electronic prescriber in 2011 for the Electronic Prescribing (eRx) Incentive Program; ho...
If an individual eligible professional’s TIN changed after 12/31/2011, he/she would need to have met the reporting cr... (more)

Is participation in the Physician Quality Reporting System or Electronic Prescribing Incentive Program mand...
No. Participation in Physician Quality Reporting System or the eRx Incentive Program is voluntary. Reference: ... (more)

When an eligible professional submits a Physician Quality Reporting System or Electronic Prescribing&n...
Yes. The Medicare Summary Notice will contain the following standard language: "This code is for informational/reporting... (more)

Why is the diagnosis history of melanoma (v10.82) not included in Physician Quality Reporting System (PQRS)...
The measure developer specified codes for Physician Quality Reporting denominator inclusion. The intent of this measure ... (more)

Can I submit a significant electronic prescribing hardship exemption request on behalf of a provider in my ...
Yes, during the 2012 eRx program year you may submit the eRx hardship exemption request on behalf of your provider. Bill... (more)

How do I find out more information about the American Recovery and Reinvestment Act (ARRA), its Health Info...
Please see http://www.cms.gov/EHRIncentivePrograms/ for additiona... (more)