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Leaving Money on the Table? Take Advantage of PQRS & eRX Incentives

Posted by Matthew Smith on Jul 19, 2013 11:00:00 AM

PQRS, eRX, e-prescribe, ehr incentives, ehrThe average 2011 payment for PQRS and eRX was $935 and $1,009, respectively. If your practice is not taking advantage of these EHR incentive payments, you are missing "free income" and leaving money on the table that should be a byproduct of your workflow

This report summarizes the reporting experience of eligible professionals in the PQRS and eRx programs in 2011, historical trends, and preliminary results for the 2012 program year.

  • 280,229 eligible professionals participated individually in the 2011 PQRS
  • Total of $261,733,236 in PQRS incentive payments was paid by CMS for the 2011 program year
  • 282,382 eligible professionals participated in the 2011 eRX incentive program (116% increase from total participants in 2010)
  • $285,049,103 in eRx incentive payments was paid for the 2011 program year
  • 135,931 eligible professionals were subject to the 2012 eRx payment adjustment because they did not qualify for exemption, meet exclusion criteria, or did not meet eRx reporting requirements in the first half of 2011.
  • The average PQRS incentive payment per provider is $935
  • Average eRx incentive payment per provider is $1009

Number of Eligible Professionals Who Qualified for an Incentive: Physician Quality Reporting System Results (2007 to 2011) and eRx Incentive Program Results (2009 to 2011)

PQRS Incentive Payment

About the Physician Quality Reporting System

What is it?

PQRS is the Physician Quality Reporting System.  It is ultimately a way to encourage the reporting of quality information by eligible professionals.  PQRS is made up of incentive payments and payment adjustments to eligible professionals.

How are incentives determined?

Eligible professionals (EP) are identified on their claims by their individual National Provider Identifier (NPI) and Tax Identification Number (TIN).  Incentive payments are given when an EP reports data on quality measures (determined by CMS) for their services provided to Medicare Part B Fee-for-service (FFS) beneficiaries.  A payment adjustment will begin in 2015 to all EPs who do not report data on quality measures for these covered services. 

What is being reported?

As mentioned above, incentive payments are based off of quality measures being reported.  The Centers for Medicaid and Medicare services (CMS) implements Physician Quality Reporting through regulations published in the Federal Register.

How Do I participate?

To participate in the Physician Quality Reporting you must qualify.  There is certain criteria to qualify you and it is specified by CMS for a particular reporting period. 

2013 Physician Quality Reporting

EPs may choose to report information on individual Physicians Quality Reporting quality measures or measures groups:

  1. To CMS on their Medicare Part B claims
  2. To a qualified Physicians Quality Reporting registry
  3. To CMS via a qualified electronic health record product
  4. To a qualified Physician Quality Reporting data submission vendor

    If you are an EP and you meet the criteria and report the quality measures in one of the ways listed above for services during the 2013 reporting period you will qualify to earn a Physician Quality Reporting incentive payment equal to 0.5% of your total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during that same reporting period.

     EHR Incentives, PQRS, eRX, EHR

    Topics: EHR, PQRS, e-prescribe, eRX, EHR Incentive Payments

    What You Need to Know to Avoid the eRx Payment Adjustment

    Posted by Matthew Smith on May 23, 2013 3:54:00 PM

    e-prescribe, prescription, emr, ehr

    A major Electronic Prescribing (eRx) Incentive Program deadline is approaching for both individual eligible professionals (EPs) and group practices participating in the Group Practice Reporting Option (GPRO). If you are an EP or an eRx GPRO participant, you must successfully report as an electronic prescriber before June 30, 2013 or you will experience a payment adjustment in 2014 for professional services covered under Medicare Part B's Physician Fee Schedule (PFS.)

    The 2013 eRx Incentive Program 6-month reporting period (January 1, 2013 to June 30, 2013) is the final reporting period available to you if you wish to avoid the 2014 eRx payment adjustment.

    If you do not successfully report, a payment adjustment of 2.0% will be applied, and you will receive only 98.0% of your Medicare Part B PFS amount for covered professional services in 2014.

    Avoiding the 2014 eRx Payment Adjustment

    Individual EPs and eRx GPRO participants who were not successful electronic prescribers in 2012 can avoid 2014 eRx payment adjustment by meeting specified reporting requirements between January 1, 2013 and June 30, 2013. Below are the 6-month reporting requirements:

    • Individual EPs – 10 eRx events via claims
    • eRx GPRO of 2-24 EPs – 75 eRx events via claims
    • eRx GPRO of 25-99 EPs – 625 eRx events via claims
    • eRx GPRO of 100+ EPs – 2,500 eRx events via claims

    Exclusions and Hardships Exemptions

    Exclusions from the 2014 eRx payment adjustment only apply to certain individual EPs and group practices, and CMS will automatically exclude those individual EPs and group practices who meet the criteria. CMS may exempt individual eligible professionals and group practices participating in eRx GPRO from the 2014 eRx payment adjustment if it is determined that compliance with the requirements for becoming a successful electronic prescriber would result in a significant hardship. Requests for hardship exemptions must be submitted by June 30, 2013. More information on exclusion criteria and hardship exemption categories can be found on the Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment Fact Sheet.

    Resources from CMS

    Additional resources o n the 2014 payment adjustment are available on the eRx Incentive Program Payment Adjustment Information webpage, including the resource Electronic Prescribing (eRx) Incentive Program: Updates for 2013.

    Questions about eRx?

    If you have questions regarding the eRx Incentive Program, eRx payment adjustments, or need assistance submitting a hardship exemption request, please contact the QualityNet Help Desk at 866-288-8912 (TTY 1-877-715-6222) or via qnetsupport@sdps.org. The Help Desk is available Monday through Friday from 7am-7pm CT.

    To learn more about the eRx Incentive Program and program alignment under the CMS eHealth initiative, please visit www.CMS.gov/eHealth.

    Topics: e-prescribe, eRX, electronic prescribing, eRx Incentive Program

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