CMS Pub. 100-22, ch. 2, § 50.2

15

Beginning with the 2010 eRx Incentive Program, individual eligible professionals and

group practices Individual eligible professionals and group practices may choose to

participate in the eRx Incentive Program via the registry-based reporting mechanism for

all reporting periods except those 6-month reporting periods associated with a payment

adjustment. Eligible professionals and group practices that choose to participate in the

eRx Incentive Program via the registry-based reporting mechanism do not have to enroll

or register to begin registry-based reporting of the eRx measure to CMS. However, to

report eRx measure data via the registry-based reporting mechanism, an eligible

professional or group practice must select a qualified clinical data registry and must enter

into and maintain an appropriate legal arrangement with a qualified clinical data registry.

Such arrangements should provide for the registry’s receipt of patient-specific data from

the eligible professional and the registry’s disclosure of eRx measure results and

numerator and denominator data on behalf of the eligible professional or group practice

to CMS. An eligible professional or group practice choosing the registry-based reporting

mechanism must submit information on the eRx measure to their selected registry in the

form and manner and by the deadline specified by the registry. Thus the registry would

act as a Health Insurance Portability and Accountability Act of 1996 (Pub. L.104-191)

(HIPAA) Business Associate and agent of the eligible professional. Such agents are

referred to as “data submission vendors.” The “data submission vendors” would have the

requisite legal authority to provide information on eRx measure results and numerator

and denominator data on the eRx measure on behalf of the eligible professional for the

eRx.

Only a registry that is qualified to submit Physician Quality Reporting System quality

measures information to CMS on behalf of eligible professionals for the applicable

program year is eligible to become a qualified registry for the purpose of submitting eRx

measure information to CMS on behalf of eligible professionals or group practices. CMS

qualifies registries for the Physician Quality Reporting System for each program year

through a self-nomination process (see Chapter 1, §50.2). The list of qualified registries

for a specific program year are made available on the CMS eRx Incentive Program

website at http://www.cms.gov/ERXincentive. For a specific program year, this list

usually is made available in the summer of that same year. For example, we anticipate

the list of qualified registries for the 2010 eRx Incentive Program was anticipated to be

made available in the summer of 2010.

Please note that, for all 6-month reporting periods associated with a payment adjustment,

only the claims-based reporting mechanism may be used for purposes of the eRx payment

adjustment. For example, for purposes of the 6-month reporting period for the 2013

payment adjustment (i.e., January 1, 2012-June 30, 2012, only the claims-based reporting

mechanism may be used for purposes of the 2013 eRx payment adjustment even though

the registry-based reporting mechanism was finalized for use by eligible professionals for

the 12-month reporting period for the 2013 payment adjustment (i.e., January 1, 2011 –

December 31, 2011) and for purposes of the reporting period for the 2012 incentive (i.e.,

January 1, 2012-December 31, 2012). As such, to the extent an eligible professional

intends to use a registry to submit eRx measure data for purposes of qualifying for the

16

2012 eRx payment incentive, the eligible professional would still need to submit eRx

measure data on claims for services furnished between January 1, 2012 and June 30,

2012, in order to avoid the 2013 eRx payment adjustment.