E-prescribe now, or risk a Medicare penalty

Doctors who do not successfully e-prescribe 10 times for Medicare patients in the first six months of 2011 using claims-based reporting may be hit with a 1% penalty on their Medicare Part B payments for covered professional services in 2012.

The penalty will increase to 1.5% in 2013 for those who don’t e-prescribe for 25 Medicare patients during 2011.

Not yet e-prescribing?

Maybe your EMR will be implemented soon, but maybe not soon enough!

If you’ve already contracted for an EMR, ask your vendor if you can leapfrog the typical implementation process so that you can submit the minimum 10 e-prescriptions before June 30.

That means that you’ll have the EMR in place, but you should use it only to e-prescribe. If you try to get into other functions and modules you’ll risk a poor implementation, and that isn’t fair to your vendor, especially if they help you out by getting you on the e-prescribing function quickly.

In addition to actually writing the prescription in the EMR and submitting it electronically to the pharmacy, you’ll need to bill G-code G8553 on the same claim form with the Evaluation and Management (E&M) code for the patient.

No EMR yet?

You may not be ready to take on the full ARRA HITECH incentive plan and bring an EMR into your practice, but that doesn’t mean that you have to accept a reduction in your Medicare Part B physician fee schedule.

If you haven’t yet made an EMR purchase, you can still e-prescribe using a dedicated application for e-prescribing while you maintain your paper charts.

The applications range from free to a few hundred dollars per provider per year.

The key is to get started fast!

You have only a few weeks to:

  1. Pick your product: two leading applications are available at www.nationalerx.com and www.rxnt.com
  2. Acquire and install hardware: you’ll need at least one PC for yourself and probably another for your nurse
  3. Learn how to use the software: include your nursing staff and your billing staff in training
  4. Determine how you’ll integrate prescribing electronically into your day-to-day visit work flow: the patient medications list will be maintained in the software application while the rest of the clinical documents are maintained in the paper chart
  5. Modify your superbill/encounter slip to accommodate the G-code G8553 to insure that you capture and submit the G-code with every visit that includes an electronic prescription.

The e-prescribing incentive program penalties were included in the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008.

Penalties increase each calendar year from 2012 through 2014. Regardless of whether or not a physician receives incentives under ARRA, he/she must continue to comply with the MIPPA e-prescribing requirements (i.e., G-coding) to avoid future MIPPA penalties.

Step up now to avoid the penalty in 2012.

Rosemarie Nelson is a principal with the MGMA Health Care Consulting Group.

Originally published in MedPage Today. Visit MedPageToday.com for more practice management news.

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  • ninguem

    The new business model.

    If your product stinks and no one wants it, use the power of government to force people to buy it.

  • solo fp

    Try figuring out how much in paid staff time and your time will be spent doing the e-scribing. Many of the smaller pharmacies do not accept e-scribing, and most states do not allow electronic prescribing of Class II meds for ADHD etc. To e-scribe, you will spend extra time maintaining an electronic database for some prescriptions and doing a paper prescription for others. Sometimes the patient does not know what pharmacy they want to go to, and they want a written rx for the $4 special or “free” local antibiotics. I figured out the Mediare penalty is about $1,000 a year to me, which is only $19 a year. This is less than 2 hours of work for an MA and less than half an office visit to me. The e-scribing also does not guarantee that the wrong drug is clicked or that too many refills are given. Be wary of clicking tons of okays for refills or having your staff do this, as it will haunt you.

  • pcp

    There is NO evidence that e-prescribing reduces errors. This is about real-time review and authorization, by CMS or private insurers, of every prescription that the physician writes.

  • buzzkillersmith

    When your time is up and your eternal rewarding is waiting for you, how much will that 1% matter?

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    This is pretty much the definition of insanity.
    Most people understood the original regulation as assessing the penalties in 2012, not applying them in 2012 based on a 2011 assessment.
    Besides, the entire Meaningful Use campaign supersedes the eRx initiative, which should be suspended. If you buy an EHR in 2011 and start using it in July, and become a Meaningful User by the end of the year, CMS will still penalize you for eRx. I somehow don’t think CMS can afford this type of negative PR right now.
    There is absolutely no point in buying computers and learning a standalone eRx application and changing your workflow, just so you can go buy more computers, learn another application and change your workflow again when you buy an EHR.

    If I were a betting person, I would bet that they change the rule to at least assess penalties against 2012, and better yet against 2013, for those buying EHRs in 2012. All they need to do is allow another “hardship” G code, denoting that the prescriber is planning on getting an EHR in 2011-2012 time frame and penalize retroactively if he/she does not, or just drop the whole thing.

  • Primary Care Internist

    “The key is to get started fast!

    You have only a few weeks to:”

    enrich EMR vendors and consultants further, shunting an even greater piece of the healthcare dollar away from actual care.

    yesterday i tried to order demeclocycline on my patient with SIADH, and the computer wanted me to order it in terms of “drops”. Yeah EMR and e-rx works great without physician input.

  • Angela Caffaratti, MD

    SoloFP… It doesn’t matter if the pharmacy accepts it. Send it and bill the code.

    Just 10 patients and one rx each. My health system is for forcing us to escript one rx for ten Medicare patients while we duplicate work and send below-standard faxes. Why cant doctors already working towards EMR get an exception to Obama law like McDonalds does with it’s substandard health plan for low wage employees?

    My office is understaffed and I resent extra effort to use free e-scribe for a few Medicare scripts.

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