Home Forums Discussions General Discussion Erx bonus vs meaningful use.

Does anyone have a definitive answer that you cannot get the bonus for ERX and meaningful use the same year - would like definitive answer - I assume you cannot get both.

Steven, you can get both.
From the CMS site: "Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes a new and separate incentive program for eligible professionals (EPs) who are successful electronic prescribers as defined by MIPPA. This new incentive program, which began on January 1, 2009, is separate from and is in addition to the quality reporting incentive program authorized by Division B of the Tax Relief and Health Care Act of 2006 - Medicare Improvements and Extension Act of 2006 (MIEA-TRHCA) and known as the Physician Quality Reporting Initiative (PQRI). Eligible professionals do not need to participate in PQRI to participate in the Electronic Prescribing (eRx) Incentive Program."

Note the words "in addition to".

http://www.cms.gov/ERXincentive/

Thanks Jon - have heard lots of conflicting stories - now just need to make sure the G code did not change for 2011 - did you note whether it did or not?

It is the same.

"Report the following eRx numerator G-code, when applicable:
G8553 - At least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system."

from

2011 eRx Measure Specifications, Release Notes and Claims-Based Reporting Principles

By the way, that document (through a download link near the bottom of this page: http://www.cms.gov/ERxIncentive/06_E-Prescribing_Measure.asp#TopOfPage) is a good summary of what we need to know about the program.

Jon & Steven,

I believe that the PQRI (1%), eRx (1%) and EHR/Meaningful Use ($18,000) are 3 separate Medicare initiatives. The 2011 PQRI program has 190 "Physician Quality Reporting System Measures". For PQRS, there are individual measures and measure groups. Using a measure group may be easier. If reporting individual measures you must report on at least 3 measures, and report on at least 50% of applicable Medicare patients. If reporting a Measures Group for 12 months, you need to report on at least 30 applicable patients. In 2011, you cannot receive incentives for both eRx and EHR, but you can receive incentives for both eRx and PQRS. Here is the PQRI summary page. I put my office manager on finding out how to qualify; it took her about 3 hours and 2 phone calls to CMS.

There is also an additional bonus payment of 0.5 percent per year available for those who participate in a maintenance of certification (MOC) program required for board certification by a recognized physician specialty organization for at least one year, and complete an MOC practice assessment.

And just to make things more interesting, PQRI penalties will begin in 2015 for those who do not satisfactorily submit quality data by that time, as well as eRx penalties beginning in 2014 for those who aren't using eRx by 2012.

I shot off an email to CMS Director Dr. Don Berwick (dberwick@ihi.org) to complain about this mess, but no reply yet. I suggest you let him know what you think of his agency's quality initiatives, since he fancies himself a quality of care guru.

I am pediatrician who mainly sees Medicaid , is PQRI relevant to me also or mainly for medicare.

This is only Medicare. There are several pediatric PQRI measures, but I don't see any reference to Medicaid.

This is from the CMS website. EP stands for eligible professional. I would read this to mean that you cannot get incentives for both the eRx and meaningful use for Medicare pts.

"The American Recovery and Reinvestment Act of 2009 specifically states that under the Medicare EHR Incentive Program, EPs cannot receive a payment under both the MIPPA E-Prescribing Incentive Program and the Medicare EHR Incentive Program for the same year. However, EPs may receive payments from both the MIPPA E-Prescribing Incentive Program and the Medicaid EHR Incentive Program for the same year".

Bill, could you provide a link for that, please? It seems to directly contradict what CMS says elsewhere.

It is in a frequently asked questions section:

http://questions.cms.hhs.gov/app/answers/detail/a_id/9846/session/L3NpZC9Od3pjZFVqaw%3D%3D

If this is true, then a lot of people are going to be furious...and I am one of them. So if get the e-Rx incentive for 2011, then file for the EHR incentive (which should be significantly larger) they will then tell me I can't get the second, larger one???

that's what it sounds like. Since you only need to submit 25 pts for the eRx bonus, don't submit any yet. You KNOW they will pay you less or not at all if possible. Get the meaningful use going and go for the eRx later if all this is a misunderstanding of the regulation.

FYI, after attending the CMS webinar on the EHR incentive program they verified that you can not do both Erx and Ehr programs during the same year. You must chose which incentive program you want to receive compensation for. The diffenence in reimbursement is unbelievable.

The erx reporting I did is for 2010 so I should be able to do the meaningful use EHR bonus for 2011. Did the code for erx for 2011 change?

This seems odd if they are going to punish us in the future for not using ERx? My understanding is the ERx code now is G8553 if any Rx is sent electronically.

At the current time the Erx reporting code is still G8553. I did ask this question specifically.

Chandra

Yeah so they will penalize you for NOT using eRx. That means that if you choose to get the meaningful use incentive, be sure to DEDUCT from that your eRx penalty.

I'm confused.