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Overview of the Medicare 2011 E-Prescribing Incentive Program
The deadline for the Medicare 2011 e-Prescribing Incentive Program is fast approaching. Many providers are scrambling to meet the June 30 deadline, with little to no direction. If this is you, read on. We have provided some facts to help guide you through the maze.
The Program
· This is an incentive program from CMS offering eligible professionals the opportunity to receive an extra one percent reimbursement in 2011 on total allowed Medicare charges to those that use e-Prescribing
· To receive payments, eligible prescribers must use qualified e-prescribing technology and send at least 10 e-prescriptions during the reporting period.
· Those that do not establish this use by June 30, 2011 will face a 1 percent payment penalty on total allowed Medicare charges submitted throughout 2012.
e-Prescribing Incentive Program and the Meaningful Use Incentive Program
Practices that successfully participate in the Meaningful Use incentive program will not be eligible for the e-Prescribing incentive program, but will still be eligible for imposition of the e-prescribing payment adjustment.
Eligible Professionals
Providers under the Medicare Act who have prescribing authority within their scope of practice.
Limited to EP's whose estimated allowed charges for "e-prescribing measure" procedural codes are at least 10 percent of their total Medicare Part B Physician Fee Schedule allowed charges for the reporting period.
Eligible Patient Encounters
The estimated allowed charges for "e-prescribing procedural codes" (see page 11) must be at least 10 percent of their total Medicare Part B Physician Fee Schedule allowed charges for the reporting period. The incentive only applies to services provided to patients within the Medicare Part B Fee-for-Service program. It does not apply to patients covered under a Medicare Advantage program.
Eligible e-Prescribing system
Eligible professionals must use a "qualified" e-prescription system. Prescribers should ask the vendor that provides their e-prescribing system if it is qualified per CMS E-Prescribing Incentive Program requirements.
"Successful Electronic Prescriber" Defined
A successful e-prescriber is one who meets all eligibility requirements and generates and reports at least one e-prescription during 25 or more unique patient visits during the reporting year.
A successful e-prescription reporting event consists of submitting the G-code (G8553) when performing one of the applicable service codes (see page 11). This G-code reflects that at least one prescription created during the encounter was generated and transmitted using a qualified e-prescription system.
Successful E-Prescriber Determination and Payment Procedure
Determination of eligible professionals who are successful e-prescribers for 2011 will be at the individual professional level, based on their National Provider Identifier (NPI). However, payment will be made to the practice represented by the Tax Identification Number (TIN) to which payments are made for the individual's professional services.
For providers associated with more than one practice, determination of a successful e-prescriber for 2011 will be made for each unique NPI-TIN combination. Incentive payments for 2011 will be made by mid-year 2012.
Exemptions
There are a few scenarios in which a provider can be exempt from the payment cuts to include license status, Number of claims with applicable codes, designation as a "successful electronic prescriber" (as defined above), and percentage of total allowed charges comprised of applicable e-prescription service codes (see page 12).
A "Significant Hardship Exemption" also exists for practices in a rural area with limited high-speed internet access or a limited number of pharmacies with e-prescribing technology.
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