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:
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.
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 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 ...
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 ...
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.
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.
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 ...