Home Forums Discussions Problems e Priscription

I am trying to decide on E Presciption software.
I am concerned about surescript after reading some of the posts. Please guide...
Thank you.

I have been using New Crop/SureScripts, which is an eRx partner with Amazing Charts. The interface is very "raw", IMHO. Slow processing, multiple windows -- really everything that AC is not. Fortunately you have a month trial before you must pay for the year in advance, so try it first.

It is slow, and once the prescription has been sent, I have to go back to the "regular" prescription tab to import the prescription into AC's medication list. I didn't use it at all towards the end of last week and now I think I have been "kicked off". Maybe the thing to do is to wait until later this year and re-try it when the RX will automatically be recorded on the AC medication list. ? Am I doing something wrong?

The interface is bad - I only use it because of the 2% medicare bonus, but if that is not an issue I would wait a few more months as Jon says they are working on improving the e prescribing. He freely admitted that it is not great, but it is all he can offer right now.

I am confused. With e-prescribing over a secure link (like sure-scripts) can you e-Prescribe Schedule II or not? I assumed you could and someone last night is telling me that you cannot?

DEA prohibits physicians to eRx any controlled drug. This may change.

I just received some alarming news about Surescripts at a health information exchange conference I attended. I wonder if any of you have heard the same? Apparently, Surescripts has become the 800# gorilla wrt e-prescribing and is now taking advantage of that by charging folks who are accessing their data a substantial per click charge. This would come into play when one provider is querying a pharmacy database to get a list of meds for their patient. I have heard that they intend to charge about $2.50 per click.

Anyone else experienced this?

Isn't SureScripts supposed to be free because they made a deal with the government?

I for one will not make enough on the 2% and the schizophrenic approach of our government, (bonus if you do, later penalty if you don't BUT DEA says you can't) pisses me off. I wish we could boycott the whole thing until it makes sense and makes it EASIER for us instead of double entry to make it HARDER. Grrrr....

Speaking of Scheduled drugs...
In Ohio we can "call in" Scheduled 4 (Lunesta & zolpidem) and Schedule 5 (promethazine w/ codeine) but we can't send them electronically. Now tell me, which is more "secure"? A prescription sent directly from physician to pharmacist or one printed or handwritten and handed to a third party who may or may not attempt to alter, copy, or forge it somewhere betwenn the office and the pharmacy?

There are very few institutions less rooted in logic and common sense than a government agency.

I feel your pain Bruce, being from Ohio. I was "cheating" by "printing" my scripts to paperport so I could electronically stamp my sig on the controlled scripts and then fax them directly thru paperport's fax, but the pharms didn't like that either. Now if I print the script and sign it by hand, then fax it, they are ok with that - where is the logic in that lol!! (or I can print it and my MA can call it in to them and they will take it- ya, that's real "secure"!!). The Ohio pharm board should just post all their regs in an easily available public location to make it easier for my drug seeking patients to get their scripts - they wouldn't even need to come up with a good story to give me to get a new script, they could just call in their own!
Ok, I better stop, my BP's jumping again. ANYWAY, what I was wondering is on this "2% bonus for eprescribing thing", is this for ALL scripts including controlled substances, since the controlled substances CAN'T be eprescribed(with some state to state variability I know)? Someone who does a lot of pain management or psychiatric care in their practice may be hard pressed to hit the 50% requirement even if they DO eprescribe is why I was asking, given the amount of controlled scripts that are typically involved in treating these patients. Plus, what is the 50% that they are looking at? Is it 50% of total scripts generated, so a 90 day mail in prescription for Actos counts the same as a two week supply of Vicodin, both being "one script"?

My understanding is that 50% of your Medicare visits have to have a e-prescribing code - their are 3 different codes - 1 is that all scrips were sent electronically (not faxed), 1 is that for some reason you did not send all electronically (pt/pharmacy preference, controlled substance, whatever) and the the last 1 being that all scrips were sent electronically. It is a G code that you send with your bill to Medicare.

Ironically - the mail order companies do not let you do them electronically as far as I can tell. This is because although some companies provide e prescribing to you for free - they charge a fee to the pharmacy to get them. One neat thing about e-prescribing is that it automatically finds out their Part D company and gives you formulary feedback (not perfect, but is getting better).

The current e-prescribing from AC does need improving and I know that Jon was working on it, but had to focus on Version 5 due to CCHIT certifcation. Once that is done I think he will get back on his other priorities. I currently do the e prescribing even though it is clunky, just to get up to speed (only on medicare - don't want to financially burden my small town pharmacies too much yet).

Bump

In Rcopia you can eRx to mail-order pharmacies such as Medco as long as the patient demographic is uniquely matched to an entry in the SureScript database. You can order up 30 locally and the rest 90 day renewable in one script.

Just an FYI: According to my biller you can only get credit for e-prescribing if it is within a visit. So any refills done electronically out of a visit (for me that is anywhere bet 10-20 RX's a day) do not count and do not have a code.

Typical Medicare - never paid for anything not face to face.

In my view the 2% is not worth pissing off a bunch of patients and potentially losing them, especially after I have spent years training them to call their pharmacy and not my office for refills. (We of course try to keep the refills in synch with the visits, yet we are probably not strict enough and we all know this isn't always successful anyways esp. with some patients and caregivers).

I guess it is possible to still get the 2% if you use the G8443 code on all your medicare visits if you do electronic refills for the pt, yet I'm sure if you didn't do it the day of the visit that would be fraud in the legal definition.

I am not sure the method of refill is relevant. The denominator for the G codes are the billed visits. Assuming that you have the same number of visits as before, all that is required for the 2% is to associate a G code for over 1/2 of the visits. The G code signals the presence of the ability to ePrescribe, and as Stephen stated, whether you prescribe or not is not relevant.

You refill workflow should be unchanged, and refills done via pharmacy calls would be reimbursed the same as before - nil, none, nada (plus 2% of it?).

You probably just need to use a G code with all medicare patients - even if 70 % of your patients you do not e-prescribe at the visit.

I see where the built in e prescribing in AC would let you do e prescribing, but places like Medco don't seem to accept them (can't find them as a listed pharmacy).

The only problem with e prescribing is that pharmacies will electronically send and then you have to remember to look there...Once AC integrates it better it will be well worth the work to do.

Yes, use one of the three G codes with all Medicare billings. Two of the G codes are for where no eRx occured, just to show that you have the capability.

So if I am reading this correctly, as long as there is a G code present on 50% of the visits, you could get the 2%...even if I never did any of the scripts electronically - as long as I had the "capability" to do them electronically is all that counts? So in theory I could hook myself up with Rcopia and never use it (lets say due to "patient preference"), yet still get credit for "e prescribing" as far as medicare is concerned. Don't get me wrong, I would love to use e prescribing as long as it does not require double entry into another system other than my EMR...but really, is this the best incentive medicare could come up with to encourage electronic scripts?!?! Wow.

I suppose you can put one of the three G codes on all your Medicare now and be paid the 2%, regardless of whether you buy Rcopia or anything else. I don't think the falsehood would be any different than having Rcopia and not using it. I doubt that CMS would check your actual ePrescribing capabilities. A lot of billing services are automatically defaulting to G8445 (no Rx) for their ePrescribing clients if no G code is circled on the superbill.

I am sure AC is going to get a better integrated ePrescriber at some point. Alternatively, you can pay for an Rcopia interface and an AC interface to have the two talk to each other. That way, demographics will flow out from AC, and Prescribing data will flow in. At our local hospital level, all our EMRs will flow to the same database - Rcopia, MPM (our other outpatient EMR), HIS, and EDIS.