E-Prescribing and Medicare Bonus Payments

Our doctors want to begin e-prescribing in order to get the Medicare bonus payment. How much is the bonus payment, and how do we let Medicare know that we are e-prescribing?

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes a new incentive program of up to 2 percent of allowed charges in 2009 and 2010 if the physician implements electronic prescribing. E-prescribing can be accomplished through a standalone e-prescribing product or through an EHR system. Some EHR systems may require an upgrade to be able to facilitate e-prescribing.

E-prescribing is defined as the transmission, using electronic media, of prescription or prescription-related information between a prescriber, dispenser, pharmacy benefit manager (PBM) or health plan. It includes, but is not limited to, two-way transmissions between point of care and the dispenser.

Benefit payments for 2009 and 2010 are authorized at 2 percent. Incentive payments will be reduced to 1 percent for years 2011 and 2012 and will be .5 percent for 2013. For those practices who do not e-prescribe by 2012, there will be a reduction in their fee schedule. Incentive payments are based on a calendar year of e-prescribing.

To report the e-prescribing, the eligible professional must report one of three “G” codes:

Yes, the reporting does entail adding another line item code. These are much like the PQRI measure codes that some practices have already implemented. We recommend that practices that begin e-prescribing include the codes on the encounter form for the provider to check to insure that they are accurately reported.

In order to be eligible for the bonus, the new G codes can only be reported with certain codes that Medicare has designated as “denominator” codes. They are 90801-90809, 92002, 92004, 92012, 92014, 96150-96152, 99201-99205, 99211-99215, 99241-99245 and G0101, G0108 and G0109.

For more information, go to http://www.cms.hhs.gov/physicianfeesched/downloads/CMS-1403-FC.pdf. Pages explaining the program begin on page 672. You may also visit the dedicated website athttp://www.cms.hhs.gov/Eprescribing.