Electronic Prescribing Incentive Update

Are you submitting prescriptions electronically to local pharmacies for your patients and reporting it to Medicare? If not, time is running out before Medicare will consider you a nonparticipant and slate you for a reduction to your Medicare reimbursements in 2012.

The MedLearn Matters SE1107 reminds physicians that the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to reduce the Medicare Part B physician fee schedule amount by 1% in 2012, 1.5% in 2013 and 2% in 2014 for nonsuccessful electronic prescribers.

CMS will utilize data gathered from January 1 – June 30, 2011 to determine who is a successful e-prescriber. It is not too late to start now as the minimum number of required prescriptions submitted electronically before June 30 is only ten. For those applying for the HIT bonus, you must also submit ten (10) claims during this time frame as well to indicate that you are an E-prescriber. (Those seeking the HIT bonus are not eligible for both the E-Rx and HIT bonus.)

This reduction does not apply if less than 10% of the provider or group practice’s allowed charges for the first six months of 2011 utilize codes in the denominator of the E-Rx measure. The denominator codes are mostly office visit codes and nursing facility codes. If the eligible professional does not have 100 cases from the denominator set for January 1 through June 30, 2011, the provider would be exempt from the payment adjustment. Additional exemptions exist if you meet the CMS definition of a hardship or do not have prescribing privileges.

For additional information, call us today for our FAQ and monograph, and visit the CMS website for MLM SE1107 at: http://www.cms.gov/MLNMattersArticles/Downloads/SE1107.pdf