March 7, 2012
Issue No. 1
In This Issue
Avoid the 1.5% Medicare Penalty in 2013
2013 Medicare eRx Incentive
Reporting Hardship to Avoide 2013 Penalty
Medicare Definition of New Patient
Prior Auths
Medicare Enrollment
Continuing Education
Quick Links
Understanding the basics of Medicare's Electronic Prescribing Program

CMS Exemption Application
Scheduler Images

Exciting Scheduler enhancement coming soon!  

Starting in April those of you who scan insurance cards and drivers licenses into Scheduler will be able to directly scan these images into Scheduler. No longer will you have to use the two step process of scanning the images to  your desktop and then uploading to Scheduler. We will keep you informed as soon as this time saver is available.

New Addition to the IPC Family
IPC employee, Julie Cavanaugh, gave birth to her daughter, Amelia, on January 23rd.


Newsletter Archive 

Want to read a back issue of IPC's newsletter?
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Important Medicare information that will affect your bottom line;

Avoid the 1.5% Medicare Penalty in 2013

If you did not successfully transmit 25 electronic prescriptions via Medicare claims in 2011, you must act quickly to avoid a 1.5% penalty in Medicare payments in 2013. To avoid this 1.5% in 2013, you need to report the ePrescribing G-code, G8553, on at least 10 unique Medicare encounters (billable office visits or services) for the January 1, 2012 through the June 30, 2012 reporting period on your Medicare Part B claim forms. All claims for services furnished between January 1, 2012, and June 30, 2012 need to be received and processed by CMS no later than one month after the reporting period. If you are e-prescribing through a qualified EHR, you may not have to report this information on claims. However, to be safe, we recommend that you also report this information on at least 10 Medicare claims by June 30th.


You can avoid the 2% penalty in 2014 in two ways:

1. Report G-code (G8553) 25 times in 2012 on Part B claims or

2. Report G-code (G8553) 10 times in the first six months of 2013 on Part B claims.

Note that the first option makes you eligible for a 1 percent incentive in 2012 as well.


2013 Medicare ePrescribing Incentive

If you report the G-code (G8553) 25 times or more on your Medicare Part B claim forms for eligible

services and visits in 2012, you may be eligible for an incentive payment equal to 1 percent of your total

Medicare Part B payments for the year.

Comparison of Medicare ePrescribing Incentive and Penalty:


Reporting Hardship to Avoid 2013 Penalty

Eligible professionals and group practices can submit an exemption form to avoid the 2013 penalty. Use the following hardship categories to determine eligibility:

  • Physician is unable to electronically prescribe due to local, state, or federal law or regulation (e.g., state law prohibits ePrescribing of controlled substances)
  • Physician prescribes fewer than 100 prescriptions between January 1, 2012 and June 30, 2012
  • Physician is located in a rural area without high-speed Internet access
  • Physician practice is located in an area without sufficient available pharmacies for ePrescribing

Eligible professionals need to apply online for an exemption from the 2013 ePrescribing penalty via the CMS website by June 30, 2012: HERE 

Medicare's Definition of New Patient

Medicare, and any insurance carrier that follows Medicare guidelines, will deny a new patient visit if you - or any other physician of the same specialty in your group practice - has had any billable face-to-face service within three years with this patient.  


According to the Medicare manual, "Interpret the phrase 'new patient' to mean a patient who has not received any professional services, i.e. E/M service or other face-to-face service (e.g. surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years."


Must Get PRIOR Auths for Payment

Both ASR Lakeland Health and United Healthcare Community Health (formerly known as Great Lakes Health Plan) require an authorization for surgeries (whether you participate with them or not) and office visits (unless you participate) PRIOR to rendering the service or the service will not be paid (no retro auths allowed!).  


If a patient has United Healthcare be sure to carefully examine the card to make sure that "(Community Health)" is not printed in small letters after the insurance name.

Medicare Enrollment

Medicare enrollment must be notified within 30 days of the following:

  • Changes in ownership, Financial or controlling interest;
  • Addition or deletion of a practice location
  • Adverse legal action
Continuing Education
IPC Employee, Sandy Reatini, Billing Supervisor, attended the following:
  • 2/01/12 MMBA (Michigan Medical Billers Association) HIPPA and Compliance Meeting in Grand Rapids  
Please let us know if there are any upcoming events your office is interested in attending with IPC.
About Us
If you have any questions regarding this newsletter, you can contact us at:

         Mary Ellen Duffy
         Patricia Nevala pat@ipcbilling.com

or call us at 616-459-6867 or 800-606-1455

Please feel free to forward this newsletter to your staff and peers.


Innovative Practice Concepts, LLC -- A full service medical billing company
Your Bottom Line is our Top Priority!