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E-Prescription Eligiblie Professionals


The eRx Incentive Program is a voluntary health care reporting program that provides an incentive payment to identified eligible professionals or self-nominated groups/organizations who satisfactorily report data on the eRx quality measure for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). The eRx Incentive Program also applies a payment adjustment beginning in 2012 to select eligible professionals if they do not become successful electronic prescribers.

Eligible professionals do not need to participate in the Physician Quality Reporting System to participate in the Electronic Prescribing (eRx) Incentive Program as an individual. Group practices who self nominate and are selected by CMS to participate in Physician Quality Reporting System through the Group Practice Reporting Option (GPRO) will be able to nominate to participate as a group through an eRx GPRO.

Eligible and Able to Participate

Below is a list of 20 professionals who are eligible to participate in the eRx Incentive Program for the incentive payment. Eligible professionals must have prescribing authority in order to participate in this incentive program.

Not all providers who are eligible to participate in the eRx Incentive Program for the incentive payment are eligible for future eRx payment adjustments. The following professionals (in normal text) are eligible to participate in the eRx Incentive Program for the incentive payment and are eligible for the 2012 payment adjustment (in bold text) if not successful at reporting the eRx Incentive Program measure:

1. Medicare physicians

• Doctor of Medicine (MD) – subject to payment adjustment
• Doctor of Osteopathy (DO) – subject to payment adjustment
• Doctor of Podiatric Medicine (DPM) – subject to payment adjustment

• Doctor of Optometry
• Doctor of Oral Surgery
• Doctor of Dental Medicine
• Doctor of Chiropractic

2. Practitioner

• Physician Assistant (PA) – subject to payment adjustment
• Nurse Practitioner* (NP) – subject to payment adjustment

• Clinical Nurse Specialist*
• Certified Registered Nurse Anesthetist* (and Anesthesiologist Assistant)
• Certified Nurse Midwife*
• Clinical Social Worker
• Clinical Psychologist
• Registered Dietician
• Nutrition Professional
• Audiologists

*Includes Advanced Practice Registered Nurse (APRN)

3. Therapists

• Physical Therapist
• Occupational Therapist
• Qualified Speech-Language Therapist

Eligible But Not Able to Participate

The following professionals are eligible to participate but are not able to participate for one or more reasons:

1. Professionals paid under or based upon the PFS billing Medicare Carriers/Medicare Administrative Contractors (MACs) who do not bill directly.

2. Professionals paid under the PFS billing Medicare fiscal intermediaries (FIs) or MACs. The FI/MAC claims processing systems currently cannot accommodate billing at the individual physician or practitioner level:

• Critical access hospital (CAH), method II payment, where the physician or practitioner has reassigned his or her benefits to the CAH. In this situation, the CAH bills the regular FI for the professional services provided by the physician or practitioner.

• All institutional providers that bill for outpatient therapy provided by physical and occupational therapists and speech language pathologists (for example, hospital, skilled nursing facility Part B, home health agency, comprehensive outpatient rehabilitation facility, or outpatient rehabilitation facility). This does not apply to skilled nursing facilities under Part A.

Services payable under fee schedules or methodologies other than the PFS are not included in Physician Quality Reporting (for example, services provided in federally qualified health centers, independent diagnostic testing facilities, independent laboratories, hospitals [including method I critical access hospitals], rural health clinics, ambulance providers, and ambulatory surgery center facilities).

Eligible professionals participating in the eRx Incentive Program and their office staff should familiarize themselves with the eRx Incentive Program requirements for the relevant program year.

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