How much is the payment?
An individual eligible professional may qualify to earn an incentive payment or receive a payment
adjustment equal to a percentage of the total estimated Medicare Part B allowed charges for covered
professional services furnished by the eligible professional during the respective reporting period. The
incentive payments for successful electronic prescribers for each authorized year are displayed in the
following table.
2009 2.0%
2010 2.0%
2011 1.0%
2012 and 2013 1.0%
In addition to the eRx incentive payment, beginning in 2012 a PFS payment adjustment applies to
those who are not successful electronic prescribers for the payment adjustment reporting period. The
payment adjustments for eligible professionals who are not successful electronic prescribers for each
authorized year are displayed in the following table.
2012 1.0%
2013 1.5%
2014 2.0%
An eRx payment is a lump sum payment based upon allowed charges for all covered professional
services (paid under or based upon the Medicare PFS only), not just those charges associated with eRx events. It is calculated at the individual eligible professional level using individual NPI data, and
(beginning in 2010) for group practices participating in the eRx GPRO, at the group practice level
using TIN data. CMS uses the TIN as the billing unit so that individual incentive payments for groups
that bill under one TIN are aggregated and paid to the TIN holder of record (regardless of whether the
incentive payment was earned by an individual eligible professional or a group practice). Because
some individuals may be associated with more than one practice, and CMS makes an incentive
payment for each unique TIN/NPI combination, an eligible professional who qualifies for the eRx
incentive payment under more than one TIN could receive a separate eRx incentive payment
associated with each TIN.
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