Home Forums Discussions General Discussion eRx - Automated way to submit to Medicare

Hello - We have been using eRx after activating the interface couple of months ago. I would like to know if there is there an automated way within AC we can report to Medicare in terms of eRx submissions.

If we dont, what would be the best way to accomplish this and qualify for the 2% incentive.

Thanks and best regards
Sekhar
Athens, GA

You have to add G code to each encouter with your CPT code when submited to medicare.
G8443, G8445, or G8446.

The 2010 G code is G8553.

Here are some prior posts about how to meet the requirements.

John,
Thanks for the correction. I did not know the code has changed for 2010. I just correct my quick code so I can use it for my medicare patients.
Thanks again.

Thank you all. Seems like this is one of the few that is easy enough to implement.

Thanks again.
Sekhar Rebala
Athens, GA

To qualify for the eRx incentive the EMR must have these qualifications:

Documents whether the eligible professional has adopted a qualified electronic prescribing (eRx) system and the extent of use in the ambulatory setting. A qualified eRx system is one that is capable of ALL of the following:
DESCRIPTION:
• Generate a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers (PBMs) if available
• Select medications, print prescriptions, electronically transmit prescriptions, and conduct all alerts (defined below)
• Provide information related to lower cost, therapeutically appropriate alternatives (if any). (The availability of an eRx system to receive tiered formulary information, if available, would meet this requirement for 2010)
• Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan (if available)


I guess Surescripts can do this but it doesn't seem to happen automatically through AC. Does anyone have it set up so that you get formulary and cost info on each Rx?

I read the incentive info to read that not only do you need a minimum of 25 visits associated with at least one eRx during the visit but that at least 10% of you total visits during the year also have to have the G code submitted. So I am going to start today but I may not make it because I see alot of Medicare. That is if we really qualify at all based on my previous post.

I don't think that this is really true.

What the 2010 eRx Incentive program requires is that "at least 10% of a successful electronic prescriber's Medicare Part B covered services must be made up of codes that appear in the denominator of the eRx measure." What I take this to mean is that you must use the CPT codes listed in the "Getting Started" guide for at least 10% of the visits on which the G8553 code is used. See List 2 in the guide for some of the codes: includes are the common office visit codes such as 99213 & 99214. It would be a rare office-based MD who doesn't have at least 10% of his Medicare billing with these codes.

I imagine that intention was to link the eRx to an actual office encounter with the physician, rather than a walk-in visit for a lab check or a flu shot.

The Guide actually has a "useful" (for a CMS document) section at the bottom: "Step by Step Getting Started".

OOOOOOHHHHHH
That's different. I guess we will see if the check arrives.

Can anyone address this issue? Do we really qualify? How do we get the formulary info to work?

I'm submitting the gcodes. I use mostly generic drugs. I have epocrates and access through AC. In epocrates I have access to formularies. Sometimes the patient has no idea what prescription drug plan they have so sometimes I can't use it but I have the capability. Funny...it is difficult to know what the preferred drug is for a given patient as the formulary preferred drugs change based on what kind of back room deal has been made with someone somewhere unknown. I have seen patient without access to certain generics but access to branded expensive med. Go figure.

Bill,

I agree with you, AC does not meet the requirement to provide tiered formulary information within the program itself. However, by using the NewCrop link that can be accessed through the AC "Medications & Prescribing" window, you can open the patient's med list, and see formulary alternatives. So I think this meets "qualified electronic prescribing (eRx) system" criteria, although the implementation is clumsy.

Just tried the NEW CROP window and the whole system froze.

So if we are using AC, does that mean we can't use the G code to get the 2% bonus this year?

Could you explain how the NewCrop works? I have been playing with it and have yet to see any formulary alternatives OR pricing for cheaper meds.

Is there a plan to fix this so AC users can get the bonus?

Newcrop has to be able to figure out insurance and then will do inaccurate tiers and formulary. Only works with Medicare part d I think.