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2012 E Prescription


With effect from Jan 1, 2012, the description for ERx G-code, G8553 has been revised to "Prescription(s) generated and
transmitted via a qualified eRx system or a certified EHR system". Earlier it was 'At least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system'.

For successful reporting under the 2012 eRx Incentive Program, a single quality-data code (eRx G-code) should be reported,
according to the following coding and reporting principles:

• Report the following eRx numerator G-code, when applicable:

G8553 - Prescription(s) generated and transmitted via a qualified eRx system or a certified EHR system (faxes do not count)

• The eRx G-code, which supplies the numerator, must be reported:

* on the claim(s) with the denominator billing code(s) that represent the eligible encounter for the 2012 eRx incentive payment; OR on the claim(s) with any billing code(s) that represent the encounter to avoid the 2013 eRx payment adjustment

* for the same beneficiary

* for the same date of service (DOS)

* by the same eligible professional (individual NPI) who performed the covered service as the payment codes, usually CPT Category I or HCPCS codes, which supply the denominator

Please note: For purposes of reporting the eRx G-code to avoid the 2013 eRx payment adjustment, the eRx G-code can be reported on the claim(s) during the reporting period, regardless of whether the code for such service appears in the denominator.

• The eRx G-code must be submitted with a line-item charge of zero dollars ($0.00) at the time the associated covered service is performed:

* The submitted charge field cannot be blank.

* The line-item charge should be $0.00.

* If a system does not allow a $0.00 line-item charge, a nominal amount, such as $0.01, can be substituted - the beneficiary is not liable for this nominal amount.

* Whether a $0.00 charge or a nominal amount is submitted to the Carrier/Medicare Administrative Contractor (MAC), the eRx G-code line is denied and tracked.

* ERx line items will be denied for payment, but are passed through the claims processing system to the National Claims History database (NCH) used for eRx claims analysis. Eligible professionals will receive a Remittance Advice (RA) which includes a standard remark code (N365). N365 reads: “This procedure code is not payable. It is for reporting/information purposes only.” The N365 remark code does NOT indicate whether the eRx G-code is accurate for that claim or for the measure the eligible professional is attempting to report. N365 only indicates that the eRx G-code passed into the NCH.

* If the entire claim is rejected, please review claim for errors before re-submitting. eRx G-codes will not be processed or tracked if the claim is rejected.

* When a group bills, the group National Provider Identifier (NPI) is submitted at the claim level, therefore, the individual rendering/performing physician’s NPI must be placed on each line item, including all allowed charges and quality-data line items.

* Solo practitioners should follow their normal billing practice of placing their individual NPI in the billing provider field (#33a on the CMS-1500 form or the electronic equivalent).

* Claims may NOT be resubmitted for the sole purpose of adding or correcting an eRx code.

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