e-Prescribing UPDATE from CMS Final Rule for Jan 1 2010November 25th, 2009 - Codapedia Editor
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.
• 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:
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
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.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Latest articles: (any category)Polysomnography Services Under OIG Scrutiny
September 2nd, 2021 - Raquel Shumway
August 16th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
August 12th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
August 10th, 2021 - Wyn Staheli, Director of Research
July 29th, 2021 - Wyn Staheli, Director of Research
July 19th, 2021 - Wyn Staheli, Director of Research
July 15th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content