HCPCS G8553 that was used for eRx claims is no longer valid for the dates of services from Jan 1, 2014

Electronic Prescribing (eRx) Incentive Program:
2014 eRx Payment Adjustment Informal Review Made Simple

HCPCS G8553 that was used for eRx claims is no longer valid for the dates of services from Jan 1, 2014

G8553 that was used for eRx claims is no longer valid for claims billed dates of service 01/01/2014 and after.

Individual eligible professionals and group practices participating in the eRx Group Practice Reporting Option (GPRO) who are not successful electronic prescribers will be subject to a 2.0% payment adjustment on their Medicare Part B services provided January 1, 2014 through December 31, 2014.

To avoid the 2014 eRx payment adjustment, individual eligible professionals would have had to have been a successful electronic prescriber in 2012 and reported the G8553 code via claims for at least 10 billable Medicare Part B PFS services provided January 1, 2013 through June 30, 2013.

The following is from the CMS website:

Background
The Electronic (eRx) Prescribing Incentive Program is a voluntary reporting program that provides
an incentive payment to identified individual eligible professionals, or CMS-selected group
practices participating in the eRx group practice reporting option (GPRO), who satisfactorily
report data on the eRx Incentive Program measure for covered PFS services furnished to Medicare
Part B FFS beneficiaries.

Eligible professionals or eRx GPROs who do not successfully report the required number of eRx
events may be subject to a payment adjustment. For complete information see the Centers for

Purpose
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
•    Eligible professionals or eRx GPROs can request a review of their 2014 eRx payment adjustment
determination during the informal review period, November 1, 2013 through February 28, 2014.
•    The informal review will be for all reporting transmission methods, including:
o Claims
o Qualified registry
o Qualified EHR
•  CMS will utilize information in the Provider Enrollment Chain Ownership System (PECOS) for
informal review processes. Be sure organization and provider information is accurate in PECOS.

How to Request an Informal Review of the 2014 eRx Payment Adjustment

Use the following steps to request an informal review of the 2014 eRx payment adjustment:

STEP 1: Individual eligible professionals or designated support staff will need to email a request
with the following information:
•     Organization’s legal business name as enrolled in PECOS

• Individual Rendering National Provider Identifier (NPI) (must be a 10-digit number, do not send a Group NPI) 

•     Eligible professional’s name as enrolled in PECOS
•     Eligible professional’s complete mailing address
•     Eligible professional’s phone number and extension if applicable
•     Eligible professional’s email address
•    The requestor relationship to the eligible professional (i.e., self, support staff, vendor)
•    Provide justification as to why the eligible professional(s) believes his/her 2014 eRx payment adjustment determination should be reviewed

The eRx GPRO contact person will need to email a request with the following information:

•     Organization’s legal business name as enrolled in PECOS
•     Organization’s complete mailing address
•     Contact person’s phone number and extension if applicable
•     Contact person’s email address
•     Provide justification as to why the group believes their 2014 eRx payment adjustment
determination should be reviewed

Note: To avoid security violations, do not include the full TIN in the email request to CMS.

STEP 2: To submit an eRx Informal review request, email CMS at
eRxInformalReview@cms.hhs.gov. Do not include the full TIN in the email request.


STEP 3: The above information must be emailed with the request to CMS. CMS must receive the
informal review request during the informal review period, November 1, 2013
through February 28, 2014.


Informal Review Decision
Eligible professionals or support staff who submit valid requests for an informal review will be
notified via email of the decision by CMS within 90 days of the submission of the original request
for an informal review. Please note that the informal review decision will be final, and there will
be no further review or appeal.

Additional Information
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive/index.html?redirect=/ERXincentive/