Medicare ePrescribing Incentives | SRSsoft

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Medicare ePrescribing Incentives

Incentive:

  • Calculated as a percentage of estimated total Medicare Part B Fee-For-Service Allowed Charges submitted by end of February of the following year, according to the following schedule:
Year ePrescribing Bonus Non-ePrescribing Penalty
2009 2% - paid Fall 2010
 –
2010 2% - paid Fall 2011
 –
2011 1% - to be paid Fall 2012 –
2012 1% 1%
2013 0.5% 1.5%
2014 and on – 2%

 

Legislation: The Medicare Improvements for Patients and Providers Act (MIPPA)

Why is ePrescribing with G-Code 8553 still important in 2012?

2012 ePrescribing prevents physicians from incurring the ePrescribing penalty (in the chart above) for 2013 and 2014.

Providers who successfully ePrescribe on 25 Medicare encounters with the specified CPT codes between January 1 and December 31, 2012 will:

  • Qualify for a 1% bonus on 2012 Medicare revenue, if they do not earn a 2012 Medicare EHR incentive
  • Avoid a 2% reduction in 2014 Medicare rates.

Providers who successfully ePrescribe on ANY 10 Medicare encounters (regardless of CPT codes) between January 1 and June 30, 2012 will:

  • Avoid a 1.5% reduction in 2013 Medicare rates.
  • Note: Providers who reported on 25 encounters in 2011 have already successfully avoided a 2013 penalty.

Requirements:

SRS ePrescribing - Surescripts Certified

1. Eligibility: Eligible providers include Medicare physicians (MDs, DOs, podiatrists, optometrists, dentists, chiropractors) and practitioners (physician assistants, nurse practitioners, nurse specialists, and others), as long as they have prescribing authority.

2. 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.

3. 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, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109

4. “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.

5. Reporting is claims-based; no program registration required.

For more information:

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