Easier E-prescribing for 2010

2010 starts the second year of The Centers for Medicare and Medicaid Services’ Electronic Prescribing Incentive Program for office-based physicians. The 2 percent incentive continues in 2010, decreasing incrementally to 0.5 percent in 2013. Beginning in 2012, CMS will pay 1 percent less than its fee schedule if you don’t e-prescribe. The penalty increases to 1.5 percent in 2013 and to 2 percent every year thereafter.

To be eligible for the bonus, a physician or nonphysician practitioner “must generate and report one or more eRxs associated with a patient visit, a minimum of 25 unique patient visits per year.” The provider must also include the eRx G-code verifying that at least one prescription was electronically prescribed during the patient visit. These codes must comprise 10 percent of the physician’s total Medicare revenue.

This is good news for physicians, as the reporting requirements have been reduced from the 2009 requirement of reporting on 50 percent of Medicare claims. However, in a significant change from the 2009 reporting requirements, CMS is requiring that providers report these measures using a qualifiede-prescribing system that is capable of the following functions:

• “Generating a complete active medication list incorporating electronic data received from applicable pharmacy benefit managers (PBMs) if available;

• Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all safety checks;

• Providing information related to the availability of lower cost, therapeutically appropriate alternatives (if any); and

• Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan (if available).”

This year CMS has updated its instructions to caution providers that “faxesdo not qualify as electronic prescribing.”

In addition, to be eligible, the provider must e-prescribe when writing a prescription while providing an office service, specifically: new or established patient visits; G0101 (pelvic and breast exam); selected psychiatry and eye codes; or diabetes management. This year, CMS has expanded the list to include home and nursing home services. There is no incentive payment for hospital-based physicians who don’t practice in a private office setting.

So, how might these changes affect your office coding procedures? Consider the following example:

A physician in your office reports to Medicare on a claims basis: i.e., by using an add-on code and submitting it with a $0.00 charge on the claim form. Any diagnosis code is acceptable. (Remember, participation is measured per eligible provider, not per medical practice.) There is only one code that will be reported, G8553. G8553 indicates that the physician is using a qualified e-prescribing program, and has used it to provide at least one e-prescription at that patient visit.

Fortunately, the e-prescribing bonus is in addition to any PQRI incentive payments your office may receive. It is also separate from the anticipated ARRA stimulus payments for “meaningful use” of a qualified electronic health record system. However, once a practice receives any stimulus money, it can no longer collect the e-prescribing bonus. So, do your practice a favor and collect your e-prescribing bonus now while you still can!

For more specifics on the 2010 Electronic Prescribing Incentive Program and current year updates visit the CMS Web site.

Betsy Nicoletti is the founder of Codapedia.com. She is the author of “A Field Guide to Physician Coding.” She believes all physicians can improve their compliance and increase their revenue through better coding. She may be reached at betsy.nicoletti@gmail.com or 802 885 5641.