Claims-based Reporting Mechanism

50.1 – Claims-based Reporting Mechanism (Rev. 10, Issued: 07-27-12, Effective: 10-29-12, Implementation: 10-29-12) Individual eligible professionals and group practices who choose to participate in the eRx Incentive Program via the claims-based reporting mechanism do not have to enroll or register to begin claims-based reporting of the eRx measure to CMS. Participating eligible professionals or group practices who bill for the services or procedures included in the denominator of the eRx measure report the corresponding appropriate numerator G-code on their claim. Claims-based reporting may be via: (1) the paper-based CMS 1500 Claim form or (2) the equivalent electronic transaction claim, the 837-P. The specifications for the eRx measure are available on the E-Prescribing Measure section page of the CMS eRx Incentive Program website at http://www.cms.gov/ERXincentive and may be updated on an annual basis. The applicable G-code quality data must be reported on the same claim as the billable service or procedure to which the QDC applies. The eRx measure does not require a specific diagnosis to help determine the denominator; therefore, any diagnosis reported on the claim is sufficient. The analysis algorithms that are used to determine whether an eligible professional is a “successful electronic prescriber” match the QDCs to the service and/or procedure codes on the claim. Thus, QDCs that are not submitted on the same claim as the applicable service and/or procedure codes do not count toward an eligible professional meeting the requirements of being a “successful electronic prescriber.” Claims-based reporting is the only reporting mechanism available for purposes of reporting on the eRx measure for the 2012 payment adjustment and for the 6-month reporting periods for the 2013 and 2014 payment adjustments. 12