Avoiding the eRx 2% Swing

February 24th, 2011

Time to get on board the eRx express.  Even if you aren't fully sold on the advantages of electronic prescribing, failure to do so will cost you one percent of your Medicare dollars beginning in 2012.  If you do participate in the program, you will get a bonus instead.

For 2012, that a two percent swing in your Medicare revenue.

CMS issued the following guidance today:

2011 Electronic Prescribing (eRx) Incentive Program Reminder-Avoiding the Adjustment
 
In November, the Centers for Medicare & Medicaid Services announced that, beginning in calendar year 2012, eligible professionals who are not successful electronic prescribers based on claims submitted between January 1, 2011 – June 30, 2011, may be subject to a payment adjustment on their Medicare Part B Physician Fee Schedule (PFS) covered professional services. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the eligible professional is planning to participate in the eRx Incentive Program. 
 
From 2012 through 2014, the payment adjustment will increase each calendar year.  In 2012, the payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice receiving 99% of their Medicare Part B PFS amount that would otherwise apply to such services.  In 2013, an eligible professional or group practice will receive 98.5% of their Medicare Part B PFS covered professional services for not being a successful electronic prescriber in 2011 or as defined in a future regulation. In 2014, the payment adjustment  for not being a successful electronic prescriber is 2%, resulting in an eligible professional or group practice receiving 98% of their Medicare Part B PFS covered professional services.
 
The payment adjustment does not apply if <10% of an eligible professional’s (or group practice’s) allowed charges for the January 1, 2011 through June 30, 2011 reporting period are comprised of codes in the denominator of the 2011 eRx measure. 
 
Please note that earning an eRx incentive for 2011 will NOT necessarily exempt an eligible professional or group practice from the payment adjustment in 2012.
 
How to Avoid the 2012 eRx Payment Adjustment

Eligible professionals – An eligible professional can avoid the 2012 eRx Payment Adjustment if (s)he:    

  • Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of Jun 30, 2011 based on primary taxonomy code in NPPES;      
  • Does not have prescribing privileges. Note: (S)he must report (G8644) at least one time on an eligible claim prior to June 30, 2011;    
  • Does not have at least 100 cases containing an encounter code in the measure denominator;     
  • Becomes a successful e-prescriber; and     
  • Reports the eRx measure for at least 10 unique eRx events for patients in the denominator of the measure. 
         

Group Practices- For group practices that are participating in eRx GPRO I or GPRO II during 2011, the group practice MUST become a successful e-prescriber.    

Depending on the group’s size, the group practice must report the eRx measure for 75-2,500 unique eRx events for patients in the denominator of the measure.For additional information, please visit the “Getting Started” webpage at http://www.cms.gov/erxincentive on the CMS website for more information; or download the Medicare’s Practical Guide to the Electronic Prescribing (eRx) Incentive Program under Educational Resources.

END OF CMS TRANSMITTAL

There are several free qualifying electronic eRx programs.  If you would like to use Practice Fusion, you can signup through our link at http://www.practicefusion.com/ccn/kla.  You will need to fax a form with copies of your DEA, etc.  Instructions are available on the website.

(KLA is a certified consultant.  Although this is our link for signup, we will not contact you directly.  If you wish our assistance, please call or email us.) 

Submitting the claims is not enough.  You must also include proccedure code G8553 on your claim form with a NON HOSPITAL BASED evaluation and management code.  For more details, unzip:  https://www.cms.gov/ERxIncentive/Downloads/2011_eRxMeasure_ReleaseNotes_ClaimsBasedReportingPrinciples111010.zip

Tags: Electronic Prescribing, Bonuses,

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