e-Prescribing UPDATE from CMS Final Rule for Jan 1 2010

November 25th, 2009 - Codapedia Editor
Categories:   E-prescribing   MIPS|PQRS|PQRI  
0 Votes - Sign in to vote or comment.

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.

###

Questions, comments?

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
The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.” So what are those requirements?
Medicare Advantage - The Fastest Growing Government-Funded Program Undergoing Multiple Fraud Investigations
August 16th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Medicare Advantage is the fastest growing form of government-funded healthcare and the rate of fraud within this segment has come under increased scrutiny. Funding is determined by the health status of each beneficiary; therefore, accurate coding based on detailed documentation makes the medical record vital to the process because some ...
Billing Dental Implants under Medical Coverage
August 12th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient’s medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.    Implants could be considered ...
New Codes for COVID Booster Vaccine & Monoclonal Antibody Products
August 10th, 2021 - Wyn Staheli, Director of Research
New codes have been announced for the COVID-19 booster vaccine, Novavax vaccine, and monoclonal antibody treatment.
Medicare's ABN Booklet Revised
July 29th, 2021 - Wyn Staheli, Director of Research
The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.
Chronic Pain Coding Today & in the Future
July 19th, 2021 - Wyn Staheli, Director of Research
Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.
How Does Global and Professional Direct Contracting (GPDC) Affect Risk Adjustment?
July 15th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
CMS recently announced the 53 Direct Contracting Entities (DCEs) that will be participating in the April 1, 2021 through December 31, 2021 Global and Professional Direct Contracting (GPDC) Model. Among those participating is Clover Health Partners, who runs an in-home primary care program that has the potential to help Medicare ...



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association