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How long do eligible professionals have to actually submit claims for ensuring the data is processed into the NCH file for analysis?

July 07, 2011

To avoid being subject to the 2012 eRx Payment Adjustment, participating eligible professionals must submit at least 10 eRx G-codes (G8553 - at least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system) on eligible claims with dates of service between January 1, 2011 and June 30, 2011. An additional requirement for eRx incentive eligibility is that at least 10% of an eligible professional's Medicare Part B allowable charges must originate/be comprised of codes from the CPT/G-codes in the measure's denominator. CMS will add all of an eligible professional's Part B allowable charges for services that appear in the denominator of the measure and divide this sum by his/her entire Medicare Part B book of business for the year. If this fraction is less than 10%, the eligible professional will not receive the 1% incentive even if the required number of prescriptions were sent electronically.

For 2012 eRx Payment Adjustment analysis, the 10 required G8553 events MUST be reported via the claims reporting option, NOT via a CMS-qualified registry or qualified EHR. The six-month claims reporting period ends after June 30, 2011. As CMS is allowing just one month to receive submitted claims into the NCH file, the deadline is July 31, 2011.

Please be aware that Medicare Part B Carriers/Medicare Administrative Contractors (MACs) only submit claims to the NCH every Friday, so the last Friday would be July 29, 2011. Participating eligible professionals are encouraged to ensure their claims have been submitted to Carriers/MACs by mid-July 2011 or earlier.

Please note: Normally a two-month time-frame after the close of the program year is allowed for completing all Physician Quality Reporting System and eRx Incentive Program claims submissions. However, for determining the 2012 eRx payment adjustment, the timeframe for receiving eRx claims is shortened to one month. An eligible professional cannot earn an incentive in both the Electronic Prescribing Incentive Program and the Medicare EHR Incentive Program, as these two programs are mutually exclusive.


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