The following professionals are eligible but are not able to participate for one or more reasons:
1. Professionals paid under or based upon the PFS billing Medicare Carriers/Medicare Administrative Contractors (MACs) who do not bill directly.
2. Professionals paid under the PFS billing Medicare fiscal intermediaries (FIs) or MACs. The FI/MAC claims processing systems currently cannot accommodate billing at the individual physician or practitioner level:
- Critical access hospital (CAH), method II payment, where the physician or practitioner has reassigned his or her benefits to the CAH. In this situation, the CAH bills the regular FI for the professional services provided by the physician or practitioner.
- All institutional providers that bill for outpatient therapy provided by physical and occupational therapists and speech language pathologists (for example, hospital, skilled nursing facility Part B, home health agency, comprehensive outpatient rehabilitation facility, or outpatient rehabilitation facility). This does not apply to skilled nursing facilities under Part A.
Eligible professionals participating in the eRx Incentive Program and their office staff should familiarize themselves with the eRx Incentive Program requirements for the relevant program year.