American College of Physicians: Internal Medicine — Doctors for Adults ®

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The Medicare e-prescribing incentive—a carrot and a stick

From the March ACP Internist, copyright 2009 by the American College of Physicians

An e-prescribing incentive program under Medicare could let physicians in a typical internal medicine practice to earn an additional $3,000 to $4,000 this year.

The incentive is limited to eligible professionals whose estimated allowed charges for defined “e-prescribing measure” procedural codes (generally office visit or consultation evaluation and management codes) are at least 10% of their total Medicare Part B Physician Fee Schedule allowed charges for the reporting period. Most internal medicine physicians and subspecialists easily meet this threshold.

The e-prescribing incentive in 2009 is 2% of the total allowed charges for professional services covered by the Medicare Part B Physician Fee Schedule. Incentive amounts for each successive year of the program will adjust to 2% in 2010, 1% in 2011 and 2012, and 0.5% in 2013.

Beginning 2012, physicians prescribing under Medicare who do not e-prescribe will face a penalty. Their total estimated Medicare Part B fee schedule amount during the year will be reduced by 1% for 2012, 1.5% for 2013 and 2% for 2014 and each subsequent year. A hardship exemption exists.

The e-prescribing system must:

  • generate an active medication list;
  • select medications, transmit prescriptions electronically, and warn the prescriber of possible undesirable or unsafe situations;
  • provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements;
  • provide information on lower-cost, therapeutically appropriate alternatives; and
  • use Medicare Part D messaging and interoperability standards.

The best way to determine if an e-prescribing system qualifies is to obtain written verification from the vendor. All EHR systems that have e-prescribing capability and were certified in 2008 by the Certification Commission for Healthcare Information Technology (CCHIT) meet these requirements. Systems certified by CCHIT in prior years may not qualify.

A specified set of service codes qualify, generally E/M office visit or consultation codes, with those in bold typically billed by internists.

Internists are expected to report one of a set of specific “G” codes indicating that they have a qualified e-prescribing system, whether or not they generated prescriptions using the system, and if not, why. The e-prescribing incentive “G” codes are:G8443, if you used a qualified e-prescribing system for all of the prescriptions,

G8445, if you had a qualified e-prescribing system, but didn’t generate any prescriptions during this encounter, and

G8446, if you had a qualified e-prescribing system, but could not electronically submit one or more of the generated prescriptions because:

  • the prescription was for narcotics or controlled substances,
  • state or federal law required phoning in or printing the script,
  • the patient asked to phone in or print the prescriptions, and
  • the pharmacy couldn’t receive an electronic transmission.

In order to obtain the incentive in 2009, you have to report one of the specific e-prescribing “G” codes on at least 50% of the occasions you submitted a claim for one of the specified e-prescribing services. The “G” code must be on the same claim form as the related service and should have a charge of $0.00.

CMS announced its intention to change the e-prescribing incentive measure in 2010 to remove the need for “G” code submissions for every applicable encounter. This administrative simplification is possible through pairing claims with Medicare Part D data.

More detailed information on the e-prescribing incentive is available on the College’s e-prescribing Web site.

The Center for Practice Improvement and Innovation produced videos covering eight topics about small practices. To watch how some real practices use teamwork to improve their practices, go online.

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