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

November 25th, 2009 - Codapedia Editor
Categories:   E-prescribing   MIPS|PQRS|PQRI  

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.


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