Home Forums Discussions General Discussion I got docked the 1% from Medicare

So I thought I did everything correctly and then I get a letter today stating I am being docked the 1% starting Jan1 2012. My partners applied for a waiver stating that they had no internet access... G8553 is the code I used and at least 200 were put in before the end of June 2011. Now I am forced to go through EOB's to prove it...I have the best system in Findlay Ohio and now to be docked...sure shoots your pride! Doctors dont like to be docked.

Same happened to me. Spent all the time and energy to attest during last fall. You know, all those check offs, i dotting and t crossing. Looking back, I think CMS was just trying to find another way to keep more funds for themselves. They got us on a technical. Attesting the EMR meaningful use easily trumps the requirements to avoid the 1% reduction, BUT NOT UNLESS YOU FILL OUT THEIR FORM by a certain date.
It's like someone handing you a $10 dollar bill with their right hand at the same time they reach around your back and take a dollar from your backpocket with their left hand.

Nate

I called my speaker of the house (a limp speaker at best) to ask his opinion. I cannot wait to see.

Might as well start charging medicare patients a "1% medicare fee". They charge for checked bags, 911 security fee and even ticketmaster charges me a convenience fee to print tickets using my own printer.

Marty it sounds like you are aware that you must report G8553 on your medicare patients (minimum 30 Medicare B or Medicare Railroad, but no other Medicare supplemental plans count).

I'm not sure by reading this thread if the others are aware that you cannot report the ERx only through MU. Rather it must be reported separately in order to avoid the 1% penalty.

It's a shame Medicare docked you the fee and now require you to prove it by EOB's. That doesn't quite sound legally appropriate to make you do this.

It is a pain, Todd, and the requirement is misleading and unfair. Hopefully you can pretty easily run a billing report for the first half of 2011 showing your G8553's and submit that. Since you needed 25, it sounds like you more than met the requirements.

As usual, I can't put into words how crazy this all looks. Think of a similar exchange at Safeway....

Seller: "... That comes to $145.44, please. Plastic or paper?"

Buyer: "Both please, and be sure to have someone carry those to the car for me. It is the silver BMW in the corner. And, I didn't bring any money, so here is an IOU from the government that the law says you have to accept because I am over 65. "

Seller: "... Oh... OK... but the IOU is only for $35.00.."

Buyer: "That all the government says you are worth."

Seller: "OK, so you owe me $110.44"

Buyer " Oh, nonono! You have to accept the $35.00 as full payment. You signed a paper that said that. And, don't let me catch you selling to anyone for LESS than that, even if they are starving, or I'll have you thrown in jail."

Seller: "But, it costs me $33.50 just to buy those groceries. And I have to pay rent, and the clerk and everyone else."

Buyer : "You'll just have to get more efficient. Here, let me sell you this $65,000 cash register. If you use it all the time, the government says it will pay you $37.00."

Seller ; " (Sigh). OK. Now please give me the other 2 dollars."

Buyer: " Sure. Now, you just have to fill out these forms in triplicate, including a full accounting of all your expenses, a certified tax return for the last three years, your mother's history of employment, and documentation that she had a green card when she immigrated from Sweden in 1920."

Seller: " But, she was three years old... she didn't get a green card."

Buyer: "Oh, I'm sorry. Then you don't get the 2 dollars more, and, what's more, you owe me $3.00 for everyone you have sold to over the last 5 years....."

In the context of ANY other transaction, this looks totally insane. Why is it we collectively think this is even vaguely rational because it involves medicine? What do we do in "real life" when we come across someone who is psychotic? Do we really agree that the CIA has implanted electrodes in our heads? If 500 people in the asylum start to tell you they have wires in their brains, does that make it real? Do you start looking for a neurosurgeon because you are feeling left out, or because "everyone's doing it?"

David,

I believe that is the wittiest, most lucid description of what we have to go through that I have ever read!!! I am going to make copies.

This is great post.
It is already posted on my message board in the office.

that's so good, But CMS won't understand it.

Nate

Are you kidding? They'll use it for training!

Hahaha!!...so true, so true.

One additional twist I just heard the other day about eRx. If the pharmacy you're eRx'ing to isn't set up to receive electronic prescriptions, the Rx clearinghouse falls back to faxing the script. Apparently, this is something that you won't see on your end, but because the pharmacy doesn't do things electronically, you don't get credit for the eRx, as far as Medicare is concerned, even if you bill the G8553 code.

Michael Jacobson

Thank you for your kudos. But, you need to understand that I am a "child of the 60's." In my residency in San Francisco in 1969, I used to listen to KALX in Berkeley broadcasting live the teargassing of student protestors, while I spent time at the free clinic. I will not rest until you have risen up against the oppressors!!

How would Medicare even know what happens at the Rx clearinghouse? You send the G8553 code to medicare when you submit your bill, right along with the ICD-9 and E&M code. Medicare doesn't know what EMR or eRx clearinghouse is being used, they just know that you are saying that you performed electronic submission of prescriptions.

We are getting docked the 1% as well. If we do the e-prescribe right now will it go away? Or are we stuck for this year?

Sounds like somewhere between your billing software --> clearinghouse ->> medicare intermediary that the G8553 code was been cleansed away as some piece of software thought it was unimportant since it had a zero charge? That's my guess

The person who told me this was a rep for a NY State Agency that helps primary care docs with MU.

What she said was that pharmacies that process prescriptions electronically send some sort of information electronically that gets logged in by Medicare. Those that only accept faxes don't do this. But she may have been mistaken.

From a CMS website (2009):

Will eligible professionals working with pharmacies who do not have the capability to accept electronic prescriptions (i.e., unable to accept NCPDP SCRIPT) be able to participate in the Electronic Prescribing (eRx) Incentive Program?

Yes. Participating eligible professionals should transmit prescriptions electronically using a qualified eRx system and report this action on claims using the appropriate G-code per the measure specification. If the pharmacy network converts an eRx into a fax because the pharmacy cannot receive eRx transmittals, this still counts as eRx. If the eRx system is only capable of sending a fax directly from the eRx system to the pharmacy, the system is not a qualified eRx system. Eligible professionals located in rural areas and who use local pharmacies should make sure the eRx system they choose is capable of two-way transmission of prescription data.



Michael Jacobson

And the F'in insanity of all this is even if the prescription has been printed through AC and has gone through the built in drug interaction checker all the safety features that in theory Uncle Sam thinks are important with prescribing have been covered(except I suppose forgery) and yet we get docked 1%. F'in idiots, makes opting out come up into consideration again. Ok enough ranting.

it's good to vent.
the government regulations don't only get in the way of patient care, they are punitive like never seen before. It's too much stress for all of us just to suck it up and take it.

From the ACP Internist Weekly newsletter:

CMS is having trouble keeping up with the volume of physician applications for eRx hardship exemptions, the agency announced.

Because of the backlog of applications, some physicians may find that they are being subjected to the 1% payment penalty despite not having received any determination from CMS on their hardship status. CMS has asked that physicians who believe they are being affected by this situation contact the Quality Net Help Desk at (866) 288-8912 or by e-mail. It will take approximately 45 days to correct payments.

CMS has also recently announced that the application period for hardship requests to avoid the 2013 payment adjustment will begin in early April and close on June 30, 2012.

To avoid the 2013 penalty and get the 0.5% bonus we would just e-prescribe 25 medicare prescriptions by June 30, 2012 and then when we bill medicare we have a $0.00 item with the CPT code of G8553.

Is this correct?

I just want to make sure I have this down.

Thanks!

Ben

You only get credit for eRx incentive (and avoid the penalty) if you do eRx at the time of a patient encounter. You must have the G8553 code submitted along with an eligible visit code(usually 99211-99215). You must do this for at least 25 different encounters at which at least one eRx was submitted.