ePrescribing
2010 Requirements:
1. Use of qualified system (Surescripts certification includes many of the required capabilities):
- Generates an active medication list for the patient.
- Allows electronic selection of medications, prescription generation, and transmission.
- Conducts all alerts, including automated prompts that warn of potentially inappropriate doses or routes of administration, drug-drug interactions, allergy concerns, and other warnings/cautions.
- Provides information on lower cost therapeutically appropriate alternatives, if any.
- Provides information on formulary or tiered formulary medications, patient eligibility and authorization requirements received electronically from the patient’s drug plan, if available.
2. Specified CPT codes* make up 10% or more of practitioner’s total Part B claims:
- 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99346, 99347, 99348, 99349, 99350, G0101, G0108, G0109
3. “G-code” G8553 (ePrescribed) is submitted at least 25 times during the year on claims for the CPT codes specified above.
- Report G8553 to report that at least one prescription was generated and transmitted using a qualified ePrescribing system during the patient encounter.
- Changes from 2009: Only one G-code; only report when you actually ePrescribe; incentive qualification based on number, rather than percentage, of claims reported.
4. Reporting is claims-based; no program registration required
Incentive:
- Calculated as a percentage of estimated total Medicare Part B Fee-For-Service Allowed Charges submitted by end of February, according to the following schedule:
| Year | ePrescribing Bonus | Non-ePrescribing Penalty |
| 2009 | 2% | – |
| 2010 | 2% | – |
| 2011 | 1% | – |
| 2012 | 1% | 1% |
| 2013 | 0.5% | 1.5% |
| 2014 and on | – | 2% |
Legislation: The Medicare Improvements for Patients and Providers Act (MIPPA)
For more information:
- Learn about physician productivity-focused ePrescribing
- CMS website: http://cms.hhs.gov/ERXIncentive
- For claims-based reporting instructions: CMS Download
- DEA Proposed Rule on ePrescribing for Controlled Substances, issued March 31, 2010, with 60-day comment period
- DEA Proposed Rule: General Questions and Answers
- Surescripts website: www.surescripts.com
- For concerns about ePrescribing results: Contact QualityNet Help Desk at 866-288-8912 or qnetsupport@sdps.org
- E-mail questions to GovtAffairs@srssoft.com
