E-Prescribing and Medicare Bonus Payments

April 1st, 2009 - Crystal Reeves
Categories:   Coding   Compliance   E-prescribing   Electronic Medical Records (EMR/EHR)   Medicare   MIPS|PQRS|PQRI  
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By Crystal Reeves, CPC, CMPE

Question

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?
Answer
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:
  • G8443 – all scripts e-prescribed
  • G8445 – no scripts needed at visit, but can e-prescribe
  • G8446 – did not e-prescribe this visit per patient request, system down, etc.
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.


 

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