Home Forums Medicare and eRx incentive program

Just received email from medicare stating that:
"In November, the Centers for Medicare and Medicaid Services (CMS) announced that, beginning in calendar year 2012, eligible professionals who are not successful electronic prescribers based on claims submitted between January 1, 2011 - June 30, 2011, may be subject to a payment adjustment on their Medicare Part B Physician Fee Schedule covered professional services."
How do we have to approach this ?

I believe you need to e-prescribe a minimum of 10 times during patient encounters before June 30, 2011 to avoid the penalty.

The bill submitted to medicare has to include a special item that indicates that at least one rx was generated electronically during that visit. It's a special G-code, that should not be charged ($0.00).

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

and

http://www.cms.gov/erxincentive/

and

http://www.cms.gov/ERxIncentive/Downloads/2011_eRx_ClaimsBasedReportingPrinciples_111510.pdf

for more information.

I'm just starting doing this, so please, correct me if I'm wrong, somebody.

Michael J
New York

Thank you for fast response.
Do you know if by doing that I will be automatically enrolled in the eRx incentive payment for 2011 ?
I've read somwhere that if I get the payment from medicare for eRx then I cannot claim meaningful usage incentive for the same time period.
Is that correct ?

That question is beyond my knowledge.
I do believe it has been discussed on this board before, however:

http://amazingcharts.com/ub/ubbthreads.php/topics/27760/E_Script_Coding_for_Medicare


Michael

I didn't realize that this topic was already discussed.
Apparently we have to report at least 10 eRx with code G8553 by June to avoid penalty in 2012 and this is not going to affect possibility to get meaningful use bonus.


Thanks for help again.

I thought it was 25.

I believe you have to do 10 to avoid penalty, 25 to get incentive.

I was under the impression as well that if you signed up for the EMR stimulus/meaningful use program, that you were not eligible for the e-RX incentive program therefore I've not submitted any G8553 codes this year. I did > 25 last year to be eligible for the 2010 money but have not received that as of yet. Since Amazing Charts is not eligible as of yet for the meaningful use criteria and will not be until later this year, does anyone know do we still send G8553s codes in for partial incentive money for this year? Just curious on what other people's thoughts are on this. I just didn't want to send in a G8553 code and then Medicare say that I'm now not eligible for the meaningful use $18,000 this year (once I submit 3 months of use of Amazing Charts once the new version is out).

Here is how I understand it:

1. You must use the code G8553 10 times in the first half of 2011 to avoid the penalty in future years.

2. You must use the code 25 times in 2011 to get the 1% incentive for 2011.

3. Payments are made in about October (e.g. your 2010 payment will arrive October, 2011).

4. With regard to your question of losing your ability to claim the MU incentive by using the eRx codes, CMS says that will not happen: "If participating in the Medicare or Medicare Advantage options for the EHR Incentive Program, eligible professionals must still report the eRx measure to avoid the penalty but are only eligible to receive one incentive payment. Eligible professionals successfully participating in both programs will receive the EHR incentive payment."

That is from this CMS FAQ.

5. "The issue of how to deal with the conflict in getting eRx vs. MU (you can't get both) is discussed here.

Sorry to make you follow the links, but it avoids restating everything.

Many advocate taking the eRx incentive in 2011, and waiting until 2012 to claim MU.
My approach will likely be use enough codes to avoid eRx penalties in the future, but take the MU payment this year (if I can get it).

Thanks for the update on this hot topic. It was nice to see Jon's e-mail about ver 6.0 and his optimism. Has anyone downloaded version 6 beta? I am going through the eprescribing as well and found out my front office lady wasn't putting the g codes on the superbill! I obviously wasn't clear enough in my explanation of this. She is doing it now.

Jon -- thank you for the update/summary. That makes sense. I'm hoping to do the meaningful use this year. We'll see how things go.

Tom (crestondoc) -- I'm currently using the beta 6 version. So far no major issues. A few things are different -- can have an office person now send in prescriptions under your name, better e-prescribing review (one click on main menu to see what has been sent), new pharmacies are showing up when going to e-prescribe as well. I hope you guys didn't get hit too bad with the tornadoes that hit Lenox. I still keep watching the bad weather back in Des Moines where I was previously. I traded tornadoes for hurricanes instead!

I've been in Miami during hurricane warning/watches. It is amazing how everyone's gaze is looking for the storm to head towards land, and the work some of the commercial properties and home owners go through with putting up plywood and shutters. Lenox got hit pretty good but it is a great small town and the city park , a center piece in that town, was cleaned up of all felled trees and playground equipment was usable again, by the next day! Lenox has a bunch of people who get it done!
Glad to hear that Ver 6 is working well. Is it on a dedicated server? Are you running 2008 SBS on the server? I was thinking about making the jump...but still undecided. I'm still contemplating updox. Sometimes I'm a little slow....must be SW Iowa! Hope all is going well for you. I probably hould have PM'd you.

To qualify do we need to write a total of 10 Rx, say for one person, or do we need 10 Medicare patients with atleast one eletronic Rx?

Must be 10 individual encounters. So you can do more than one on the same patient if you see them different days, but not multiples on a patient seen on one given day.