One additional twist I just heard the other day about eRx. If the pharmacy you're eRx'ing to isn't set up to receive electronic prescriptions, the Rx clearinghouse falls back to faxing the script. Apparently, this is something that you won't see on your end, but because the pharmacy doesn't do things electronically, you don't get credit for the eRx, as far as Medicare is concerned, even if you bill the G8553 code.
Michael Jacobson
How would Medicare even know what happens at the Rx clearinghouse? You send the G8553 code to medicare when you submit your bill, right along with the ICD-9 and E&M code. Medicare doesn't know what EMR or eRx clearinghouse is being used, they just know that you are saying that you performed electronic submission of prescriptions.
The person who told me this was a rep for a NY State Agency that helps primary care docs with MU.
What she said was that pharmacies that process prescriptions electronically send some sort of information electronically that gets logged in by Medicare. Those that only accept faxes don't do this. But she may have been mistaken.
From a CMS website (2009):
Will eligible professionals working with pharmacies who do not have the capability to accept electronic prescriptions (i.e., unable to accept NCPDP SCRIPT) be able to participate in the Electronic Prescribing (eRx) Incentive Program?
Yes. Participating eligible professionals should transmit prescriptions electronically using a qualified eRx system and report this action on claims using the appropriate G-code per the measure specification. If the pharmacy network converts an eRx into a fax because the pharmacy cannot receive eRx transmittals, this still counts as eRx. If the eRx system is only capable of sending a fax directly from the eRx system to the pharmacy, the system is not a qualified eRx system. Eligible professionals located in rural areas and who use local pharmacies should make sure the eRx system they choose is capable of two-way transmission of prescription data.
Michael Jacobson
