Home Forums Discussions General Discussion E-Script Coding for Medicare

I don't know if this has been discussed here yet. My billing company just informed me that I need to start using a new G code for every medicare patient getting an E-script. If we do not do this, we get docked 1%. I thought we were going to get a carrot, but now it looks like a stick.

You better find out what g code - if you use the one for medicare e prescribing you may not get meaningful use dollars - important to verify what they tell you.

Why would you not get meaningful use dollars if you are e-prescribing?

Sadly, you missed the carrot years, and have now had your introduction to the governmental stick.

Something that has been brought up here already, but remains to be seen how it will play out is if choosing one form of CMS pay-out will limit what other CMS $$$ you can claim.

I saw a supposedly CMS sourced matrix last month, but there is obviously much still in flux.

Beware anyone whose opening line is "We're from the Government, and we're here to help you."

There is already enough problem for them with people opting out of Medicare. Start showing us the stick and they will see what happens...

Oh how I wish I could believe that, Chris, but us old timers said the same thing when insurance companies started throwing their weight around with managed care in the 1980's. But they won and we now have poorly managed care in the 21st century. Doctors notoriously are not ones to buck the system. It was not that long ago that I said I would not Eprescribe unless it improved my patient care. Well, guess who is eprescribing now because it improves my bottom line? They know our weak spots.

Leslie: how is it improving your bottom line? Are you getting some carrot?

I got several thousand dollars last year from doing e prescribing and a PQRI (used my national association's program - took less than 3 hours - was free, now 200.00).

The confusing thing is that much of the CMS pages say you cannot participate in the ERX and Meaningful use - other pages say you must use the code for ERX or you will start getting punished (less money) in 2012.

The carrot isn't gone yet. In 2011 your bonus is 1%. In 2012 the stick comes out, with a 1% penalty, which increases to 1.5% in 2013 and 2% in 2014.

As Steven points out, there is a confusing "Catch-22" with the incentives. If anyone knows the solution to this, please speak up. I will try to outline the issue without droning on too long:
1. The eRx incentive turns into a penalty in 2012. The penalty is determined by whether or not you use eprescribing in 2011. You must use it and report the code (G8553) in the first half of 2011 to avoid penalties in 2012-15.
2. The biggest portion of the meaningful use incentives is earned in 2011. You apply for this as you go through the year in 2011.
3. You cannot get both of these payments; if you get the eRx incentive, you cannot get MU, and vice versa.

So....if you use the G codes in early 2011 to avoid the penalties in subsequent years, do you eliminate your chance of getting the (much larger) meaningful use incentive? Or are you better off NOT using the eRx codes, taking the penalties over the years, but getting the MU incentive? It appears that we must make a choice.

This really needs to be clarified. How many times do you have to use the Gcode for eprescribing? It is a different code for 2011 than for 2010?? It isn't alot of money either way....but not money we should be leaving on the table.

?For purposes of determining which eligible professionals or group practices are subject
to the payment adjustment in 2012, CMS will analyze claims data from January 1, 2011-
June 30, 2011 to determine if the eligible professional has submitted at least 10
electronic prescriptions during the first six months of calendar year 2011.?

So you need 10 in the first half of 2011 and 25 for the year to avoid any penalty.

http://www.cms.gov/ERxIncentive/Downloads/2011eRxIncentiveProgramUpdatefor2012PaymentAdjustment.pdf


"Reporting one QDC (G8553) for the eRx measure to CMS through claims, or submission via a qualified registry or a qualified EHR will indicate intent to participate."

So the code is the same.

Jon does point out a dilemma: if you report G8553 in 2011, you are indicating enrollment in the 2011 eRx incentive (and therefore you can't claim EHR Meaningful Use in 2011). If you don't report G5883 in the first half of 2011, then you receive penalties starting in 2012.

Not really surprising, considering the rules are written by CMS !

I suspect that if a participating doc registers for the EHR Incentive in 2011, this will satisfy the eRx requirement and avoid penalties in 2012. One of the Core Meaningful Use Measures is attesting that 40% of non-controlled prescriptions are generated and transmitted electronically. However, since this is not clear in the CMS FAQs. I have submitted this question . I'll post back if and when CMS has a response.

Personally, I may play it safe & avoid future penalties by submitting eRx G5883 incentive codes for 2011, then go for the 1st year of the EHR incentive in 2012, when AC version 6 has matured a bit. It is still possible to get the full $44,000 if you start the first year in 2012.

How does one apply G8853 to and ERx in AC?
Grenville

Grenville, all you need to do is add the Gcode to your claim form along with the E&M code for the visit at which you eprescribed. You enter zero for the fee.

Ryanjo that is very helpful. I will be interested in the reply from CMS.

I am eagerly awaiting John's investigation - I am reluctant to use the G8853 now until I figure this out as I d not not want to lose my meaningful use bonus this year.

I eagerly await version 6 - someone has to jump in and use it when it first comes out.

It is important to note that even if not participating in e-Rx program, per se, you will be penalized beginning in 2012 if you do not submit at least 10 G-codes by June of 2011 showing that you are e-prescribing. See my post in general discussion titled medicare carrots (and sticks). Although you cannot take E-Rx bonus money in same year you take EHR bonus money - there will be no e-Rx bonus money in 2012 when EHR money becomes available - only e-Rx penalty of 1% deduction if you did not already submit your G codes in 2011 (must do 10 before June!). Nothing wrong if you want to wait until May to submit 10 codes... But we shall see how many clarifications and interim final rules it takes to get us there.
Good luck.

So really we will be able to claim the EHR money in 2012 even though using the G e-script codes because there IS NO e-script bonus in that year?

That is how I understand it. Because by 2012 it is expected we all will e-prescribe (or face monetary penalty). The craziness of it all - really is astounding. A number of docs in our community have long ago opted out of medicare - and they point to this craziness as more proof for them to not take it.

Just my opinion, but I suggest that everyone just go ahead and get those 10 G8553 codes to qualify for the 1% eRx incentive for 2011 and avoid the penalty in 2012-2015. I don't think anyone should be counting on HITECH money (from the EHR incentive) this year, because:
-- The rollout of AC version 6 seems to be delayed. If version 6 comes out much into the 2nd or even 3rd quarter of 2011, you may be hard pressed to get up to speed with version 6 and meet Meaningful Use for 90 days in 2011.
-- At least one bill has been introduced in Congress which may "defund" or reduce EHR incentive payments.

That eRx incentive may be out of reach by the time these 2 scenarios play out, if you don't have 10 G8553's by June. Remember that you can still start your 1st year of the EHR incentive in 2012 and still get the full $44,000 (if HITECH survives the budget cuts).

Just my take on the matter.

I think Version 6 will come out in the next month or so - that does not include the PM component and AC states that the meaningful use version is doing in house testing.

I am concerned as to if you submit these g codes if it will affect the MU incentive. The various sites are conflicting - will probably go ahead and submit codes (can do 10 in one day without problems). Have received PQRI and erx last year.

Can someone please tell me how to use G8553 in Amazing Charts? It's not a option from the CPT library. Can it be added manually?

Go to main menu: VIEW then click ADMINISTRATOR OPTIONS. enter password and make sure Administrative / Program Settings is selected (default). Then on the Adminstrative Options menu select TOOLS from the dropdown menu and select CPT Databases: Modify available codes. Under the Codes field (white box) type in G8553 (nothing should pop-up), then at the bottom of the screen click the ADD NEW CODE radio button. This will cause a screen change. At the bottom type in G8553 in add new code and give it some clever description like: e-prescribed. You will need to add a charge. Enter $0.00 you must start charge with the dollar sign, and end with decimal followed by two decimal places or it will crash the system (my unfortunate experience with previous version - have not tried it since). Check the box to make it common and hit SAVE changes. NOW "x" out of there one time to come back to Administrative Options menu. Select (on the bottom row) Define Quick Codes for Billing. Click the Add button and add in your code and clever title and select OTHER from the drop down menu. Click the other Add button and Viola. Done. X out. X out. Giver her a try.
Good luck

So here is the answer from CMS:
multiple incentive question

It looks like you should still send the eRX codes (G8553) to avoid the eRx penalty. If you then file for the EHR incentive, you will get that one (but not the eRx incentive).

So you DO want to send the eRx codes now to avoid a penalty later.

Thanks, Jon.

Excuse me for a bit of confusion. Did the G code change this year? I have been coding G8443 for eprescribing. Please clarify correct code and if it changed. Thanks!

The correct G code for this year's eRx incentive is G8553.

Better start using the correct code ASAP, and not only to get the incentive. You will be penalized beginning in 2012 if you do not submit at least 10 G8553 eRxs by the end June 2011 (see Jon's post above.

Alberto, we just became aware of this requirement and your post saved alot of time. Thank you for all details. Really nice.