CMS released its Physician Final Rule 10-30-09! They made e-prescribing easier.
Starting Jan 1 2010, physicians can show that they have and are using a qualified e-Prescribing program by reporting on 25 claims only, (per eligible professional, not per practice) for the entire year. In addition, there is only one code that will be reported, (on a claims basis, with the appropriate office based service described below) G8553. G8553 indicates that the physician or other eligible professional has a qualified e-Prescribing program, and used it to provide at least one prescription at this visit. CMS reasons that if a physician has a program, and changes their work processes, then there is no added benefit to reporting on the additional changes.
G8553 is a code change from 2009--many thanks to the commenter who found this on the CMS website and posted the clarification.
e-Prescribing is:
• Medicare initiative to encourage physicians to use electronic methods to submit prescriptions to pharmacies.
• Physicians who use a qualified e-Prescribing program are eligible for a 2% bonus of Medicare allowances for 2009
• Using an e-Prescribing program starts as an incentive—not using one becomes a penalty!
• Claims based program. Report G-codes with $0.00 value with an E/M service, any diagnosis
Bonus/incentive payment for successfully reporting on claims for each year:
Bonus Year
2% 2009
2% 2010
1% 2011
1% 2012
0.5% 2013
Penalty Year
1% 2012
1.5% 2013
2% 2014
Qualified e-prescribing program
Documents whether provider has adopted a qualified e-prescribing system and the extent of use in the ambulatory setting. To qualify this system must be capable of ALL of the following:
• Generating a complete active medication list incorporating electronic data received from applicable pharmacy drug plan(s) 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)
• Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements
received electronically from the patient’s drug plan
For 2010: report on 25 claims per eligible professional:
G8553:At least one prescription created during the encounter was generated and
transmitted electronically using a qualified eRx system
For 2009:
Report on 50% of claims for a new patient visit, an established patient visit or office or outpatient consult: (99201-99205, 99211-99215, 99241—99245). Also report on these eye codes: (92002, 92004, 92012, 92014) and these psych codes (90801, 90802, 90804, 90805, 90806, 90807, 90808, 90909) these health anc behavioral assessment codes: 96150. 96151, 96152) and the screening pelvic and breast exam (G0101) and diabetes outpatient self management codes: (G0108, G0109). At least 10% of all revenue must be from these codes to be eligible. Only report on these services, not on hospital services, procedures, labs, etc. Only these specific codes.
G8443: All prescriptions created during the encounter were generated using a qualified e-Prescribing system
G8445: No prescriptions were generated during the encounter. Provider does have access to a qualified e-Prescribing system
G8446: Some or all prescriptions generated during the encounter were handwritten or phoned in due to one of the following: required by state law, patient request, or qualified e-Prescribing system being temporarily inoperable
There are no specific diagnosis codes required.