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07/27/2010

Electronic Prescribing (eRx) Incentive Program 2010 Updates

By Joy Newby, LPN, CPC, PCS, Newby Consulting, Inc.

Medlearn Matters article SE1021 reminds eligible professionals that they may begin reporting eRx at any time throughout the 2010 program year of January 1, 2010, through December 31, 2010, to be eligible for the incentive. Eligible professionals do not need to sign up or pre-register to participate in the 2010 eRx incentive program.

For 2010, eligible professionals who successfully report the eRx measure will become eligible to receive an eRx incentive equal to 2.0 percent of their total Medicare Part B Physician Fee Schedule (PFS) allowed charges for services performed during the reporting period. 

Beginning in 2012, eligible professionals who are not successful electronic prescribers will be subject to a PFS payment penalty:

2012            -1.0 percent

2013            -1.5 percent

2014            -2.0 percent

eRx Incentive Program Eligibility Criteria for 2010: Reporting Requirements

To be considered a successful eRx prescriber and be eligible to receive an incentive payment, you must generate and report one or more electronic prescriptions associated with an eligible patient visit on a minimum of 25 unique visits per year.

G8553 is the code to report that at least one prescription was electronically prescribed during an eligible visit. The following codes are considered eligible visits.

90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109

Electronically generated refills do not count and faxes do not qualify as eRx. New prescriptions not associated with one of the above codes are not accepted as an eligible patient visit and do not count towards the minimum 25 unique Rx events. We have found that some physicians are reporting eRx code G8553 with other CPT and HCPCS codes, e.g., 99024, 17000, etc. While not technically incorrect, please realize that these claims will not be applied to the 25 minimum number of visits per year.

Qualified Reporting System Requirements

Eligible professionals must have adopted a “qualified” eRx system. There are two types of systems: A system for eRx only (stand-alone) or an electronic health record (EHR) system with eRx functionality. 

Regardless of the type of system used, to be considered “qualified” it must be based on ALL of the following capabilities:

• Generates a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers if available;
• Selects medications, printing prescriptions, electronically transmitting prescriptions, and conducting all alerts;
• Provides information related to lower cost, therapeutically appropriate alternatives (if any). The availability of an eRx system to receive tiered formulary information, if available, would meet this requirement for 2010; and
• Provides information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan, if available.

Reporting Mechanisms for 2010

If you have not yet participated in the eRx program, you can begin by reporting eRx data for January 1, 2010, through December 31, 2010, using any of the following three options:

• Claims-based reporting of the eRx measure. - Claims-based reporting means the physician provided a service described by one of the codes above. When at least one prescription was generated and transmitted electronically, in addition to reporting one of these CPT/HCPCS codes, the physician will also report G8553 on the same claim.
• Registry-based reporting using a CMS-PQRI qualified registry. EPs have the option of using a qualified registry to assist in collecting eRx measure data and submitting 2010 data to CMS during the first quarter of 2011. The registry will submit this quality data directly to Medicare, eliminating the need for adding the G8553 to the Medicare Part B claim; and
• EHR-based reporting, using a CMS-PQRI qualified EHR product, submitting 2010 data to CMS during the first quarter of 2011.

Only registries and EHR vendors who have been selected by CMS for the 2010 PQRI/eRx and are on the posted list of registries/EHR vendors are eligible to be considered “qualified” for purposes of the 2010 eRx Incentive Program. CMS qualified registries and EHR vendors can be located on the CMS website at http://www.cms.gov/ERxIncentive/08_Alternative%20Reporting%20Mechanism.asp#TopOfPage