MEDICARE E

Medicare E

Medicare E

Introduction

The Medicare e-prescribing incentive is a new initiative authorized under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

The program starts January 1, 2009 and offers incentives for eligible providers that meet certain criteria (AcademyHealth, 2000). The e-prescribing Incentive Program is currently based on one e-prescribing quality measure that is currently included in the Physician Quality Reporting Initiative (PQRI) (AcademyHealth, 2000). Beginning in 2009 the e-prescribing quality measure will be removed from the PQRI and it will become the quality measure used in the e-Prescribing Incentive Program.

Discussion

For 2009 the e-prescribing incentive amounts will be 2% of the total estimated allowed charges for professional services covered by Medicare Part B and provided by an eligible professional during the reporting period. To be a successful e-prescriber, you must report the e-prescribing quality measure through your Medicare Part B claims on at least 50% of applicable cases during the reporting year (Agency for Health Care Policy and Research, 2005).

To participate in the e-prescribing incentive program you must use a "qualified" e-prescribing system. There are essentially two types of systems: a system for e-prescribing only (a "stand alone" system), or an electronic health record (EHR) system with e-prescribing capabilities (Agency for Health Care Policy and Research, 2005).

To get the incentive in 2009, you have to report on the e-prescribing quality measure with one of the three appropriate G codes on more than 50% of applicable cases within your practice (Agency for Health Care Policy and Research, 2005).

Eligible providers that are not "successful e-prescribers" by 2012 will be subject to a differential payment (penalty) beginning in 2012.

It's certainly worth any practice that bills a substantial amount of Medicare to enroll in the e-prescribing program in order to reap the financial benefits and in essence, improve efficiency within your practice (Agency for Health Care Policy and Research, 2005).

Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, and other general medical practice consulting services.

The final rule issued in a November 7 Federal Register notice requires that standards for certain electronic prescriptions be developed by standards development organizations accredited by the American National Standards Institute (ANSI). CMS supported its reasoning in the February 4 proposed rule stating that “the ANSI accreditation process is open and based upon consensus, so accredited standards are more likely to adequately address, and effectively respond to, industry needs.”

The requirement is one of three criteria established by the National Committee on Vital and Health Statistics (NCVHS) to assess standards for adequate industry experience (Agency for Healthcare Research and Quality, 2002). The other criteria include the implementation of a standard among multiple partners to ensure interoperability and recognition by key stakeholders (Agency for Healthcare Research and Quality, 2002). Relevant, efficient, consensus-based e-prescription standards are critical to the MMA objectives of providing quality health care and patient ...