Payment Adjustment Information

Electronic Prescribing (eRx) Payment Adjustment Information

Beginning in 2012, Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (P.L.110-275) (MIPPA) requires CMS to subject eligible professionals who are not successful electronic prescribers under the eRx Incentive Program to a payment adjustment. This payment adjustment applies to all of the eligible professional's Part B-covered professional services under the Medicare Physician Fee Schedule (MPFS). From 2012 through 2014, the payment adjustment will increase with each new reporting period. Accordingly, for 2012, eligible professionals receiving a payment adjustment will be paid 1.0% less than the MPFS amount for that service. In 2013 and 2014, the payment adjustment increases to 1.5% and 2.0% respectively.

Significant Hardship Exception: Eligible professionals may be exempt from the application of the payment adjustment if CMS determines that compliance with the requirement for being a successful electronic prescriber would result in a significant hardship. This hardship exception is subject to annual renewal.

For all inquiries regarding the eRx Incentive Program payment adjustment, including if an eligible professional believes a payment adjustment was erroneously applied, please contact the Help Desk Support. Contact information for the Help Desk Support is available by clicking the "Help Desk Support" link at left.

2014 eRx Payment Adjustment

Quick Reference Guide for Understanding 2014 eRx Payment Adjustment 

A quick reference guide for understanding the 2014 eRx Payment Adjustment has been posted to this page. This document describes how the 2014 eRx payment adjustment was 1) assessed and 2) applied for individual eligible professionals (EPs) and group practices participating in the eRx Group Practice Reporting Option (GPRO).   To view click on the following link: Quick Reference Guide for Understanding 2014 eRx Payment Adjustment (PDF). 

2014 eRx Incentive Program Payment Adjustment Informal Review Made Simple

This Fact Sheet provides step-by-step guidance for those eligible professionals and eRx GPROs receiving the 2014 eRx payment adjustment who wish to request an informal review of the 2014 eRx payment adjustment determination. This document does not provide guidance for other Medicare or Medicaid incentive programs, such as the Maintenance of Certification Program or the Electronic Health Record (EHR) Incentive Program.
Informal Review – Quick Facts.  To view click on the following link 2014 eRx Incentive Program Payment Adjustment Informal Review Made Simple (PDF). 

2014 eRx Payment Adjustment Feedback Report User Guide

A quick reference guide for understanding the 2014 eRx Payment Adjustment Feedback Report has been posted in the "Downloads" section below.  The 2014 eRx Payment Adjustment Feedback Report User Guide is designed to assist eligible professionals, group practices participating in eRx Group Practice Reporting Option (GPRO), and their authorized users in accessing and interpreting the 2014 eRx Payment Adjustment Feedback Report.

2013 eRx Incentive Program: 2014 Payment Adjustment.

This article provides guidance on avoiding the 2014 eRx payment adjustment.  To view click on the document titled "2013 eRx Incentive Program: 2014 Payment Adjustment" in the "Downloads" section below.

eRx Incentive Program: Updates for 2013

This Fact Sheet contains information about changes to the 2013 eRx Incentive Program incentive payment and the 2014 eRx payment adjustment as authorized by MIPPA. To view click on the link titled "eRx Incentive Program: Updates for 2013" in the "Downloads" section below.

A Guide for Understanding the 2013 Electronic Prescribing (eRx) Incentive Program Incentive Payment

This document describes how the 2013 Electronic Prescribing (eRx) Incentive Program incentive payment was calculated for 1) individual eligible professionals, and 2) group practices that self-nominated to participate under the eRx Group Practice Reporting Option (GPRO).  To view click on the link following link: A Guide for Understanding the 2013 Electronic Prescribing (eRx) Incentive Program Incentive Payment (PDF).

Tips for Using the Quality Reporting Communication Support Page

A document titled "Tips for Using the Quality Reporting Communication Support Page" has been posted below in the "Downloads" section.  This document provides tips for entering an eRx Hardship Exemption Request to avoid the 2014 eRx Payment Adjustment, a PQRS/eRx Feedback Report Request, a PQRS Informal Review Request and a Self-Nomination Request.  Please note self-nomination only applies to certain entities, including Maintenance of Certification Boards, Registries, EHR vendors and group practices wishing to participate in the Group Practice Reporting Option (GPRO).

Communication Support Page User Manual

The Communication Support Page is available through QualityNet (www.qualitynet.org). A User Manual has been developed to provide step by step instructions on how to navigate through the Communication Support Page. To view this guide click on the link titled "Communication Support Page User Manual" in the "Related Links" section below.

2013 eRx Payment Adjustment

2013 eRx Payment Adjustment Informal Review Made Simple

This Fact Sheet provides step-by-step guidance for those eligible professionals and eRx GPROs receiving the 2013 eRx payment adjustment who wish to request an informal review of the 2013 eRx payment adjustment determination.  To view click on the link titled "2013 eRx Payment Adjustment Informal Review Made Simple" in the "Downloads" section below.

2013 eRx Payment Adjustment Quick Reference Guide

A quick reference guide for understanding the 2013 eRx Payment Adjustment has been posted in the "Downloads" section below.  This document describes how the 2013 eRx payment adjustment was 1) assessed and 2) applied for individual eligible professionals and self-nominated and CMS-selected group practices participating in the eRx Group Practice Reporting Option (GPRO).

2012 eRx Payment Adjustment

Quick-Reference Guide for Understanding the 2012 eRx Payment Adjustment

A document titled "Quick-Reference Guide for Understanding the 2012 eRx Payment Adjustment" has been posted below in the "Downloads" section.  This document describes how the 2012 eRx payment adjustment was 1) assessed and 2) applied for individual eligible professionals and self-nominated and CMS-selected group practices participating in the eRx Group Practice Reporting Option (GPRO).