2011 eRx Incentive Program rules and Regulations

Electronic Prescribing (eRx) Incentive Program Statutory Authority - Statute/Regulations

Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized a new and separate program for eligible professionals who are successful electronic prescribers for 2009 through 2013, as detailed in MIPPA. A link to the MIPPA legislation can be found in the "Related Links Outside CMS" section below. For 2009 and 2010, the Secretary is authorized to provide successful electronic prescribers an incentive payment equal to 2.0% of the total estimated allowed charges submitted not later than 2 months after the end of the reporting period (January 1, 2009 – December 31, 2009). For 2011 and 2012, eligible professionals who are successful electronic prescribers may qualify to earn an incentive payment equal to 1.0% of the total estimated allowed charges submitted not later than 2 months after the end of the reporting period. For 2013, the incentive payment amount is reduced to 0.5%. Beginning in 2012, eligible professionals who are not successful electronic prescribers may be subject to a payment adjustment, or penalty. Specifically, for 2012 through 2014, if an eligible professional is not a successful electronic prescriber for the reporting period for the year, the PFS amount for covered professional services furnished by such professional during the year shall be less than the PFS amount that would otherwise apply by 1.0% for 2012, 1.5% for 2013, and 2.0% for 2014.

More detailed information regarding eligible professionals may be found by clicking on the "Eligible Professionals" section page to the left.

2011 eRx Proposed Rule

The Centers for Medicare & Medicaid Services released a proposed rule for changes to the Medicare Electronic Prescribing (eRx) Incentive Program. The proposed rule has been published in the Federal Register on June 1, 2011. The Federal Register published version has now been posted. To view the proposed rule, see link titled "2011 PFS Proposed Rule -- CMS-3248-P" in the "Related Links Outside CMS" section below. The deadline for submitting comments to the proposed rule is July 25, 2011.

2011 eRx Incentive Program Regulations

CMS' proposals for the 2011 eRx incentive as well as our proposals for implementing the eRx payment adjustment that begins in 2012 can be found in the 2011 Medicare Physician Fee Schedule (PFS) proposed rule. The 2011 PFS proposed rule was published in the Federal Register on July 13, 2010. The deadline for submitting comments to the proposed rule is August 24, 2010. To view the entire 2011 PFS proposed rule, including instructions for submitting comments, click on the "2011 PFS Proposed Rule -- CMS-1503-P" in  below.

The 2011 eRx Incentive Program, including the requirements related to the eRx payment adjustment that begins in 2012, was finalized in the 2011 PFS final rule with comment period. The final regulation is on display at the Federal Register. To view the entire 2011 PFS final rule with comment period, see "2011 PFS Final Rule -- CMS-1503-FC" in below.

2010 eRx Incentive Program Regulations

CMS' proposals for the 2010 eRx Incentive Program, including the proposed criteria that CMS will use to determine what eligible professionals the eRx incentive applies to and how "successful electronic prescriber" will be defined for 2010, can be found in section G5 of the 2010 PFS proposed rule (74 FR 33593 through 33600). The 2010 PFS proposed rule was published in the Federal Register on July 13, 2009.
The 2010 eRx Incentive Program was finalized in the 2010 PFS final rule with comment period (74 FR 61849 through 61861). The final regulation was published in the Federal Register on November 25, 2009.

2009 E-Prescribing Incentive Program Regulations

Detailed information about the criteria that CMS will use to determine what eligible professionals the eRx incentive applies to and how "successful electronic prescriber" is defined for 2009 are described in section O2 of the final 2009 Physician Fee Schedule (PFS) rule (73 FR 69847 through 69852) that was published in the Federal Register on November 19, 2008.