Physicians to receive incentives for electronic prescribing beginning 2009, penalties start in 2012

Over the next five years, family physicians must transition to electronic prescribing for Medicare patients or else face penalties under a provision set forth by Medicare legislation passed last month.

To help defray the cost of the new systems, the Medicare Improvements for Patients and Providers Act of 2008 authorizes Health and Human Services to provide incentive payments from 2009 to 2013 to physicians who successfully implement e-prescribing measures, either under Physician Quality Reporting Initiative guidelines or under Medicare Part D at a level determined by CMS.

Physicians who use e-prescribing for all Medicare Part B-covered services will be eligible for a 2-percent bonus starting in January 2009 and through 2010, representatives from the Dallas regional office of the Centers for Medicare and Medicaid Services told health care advocates, health care professionals and others on a conference call last week. In 2011 and 2012, physicians will receive a 1-percent bonus, and in 2013 and beyond, physicians can receive a 0.5-percent bonus.

Penalties for not e-prescribing will be assessed starting in 2012 with a 1-percent penalty, increasing to a 1.5-percent penalty in 2013 and a 2-percent penalty in 2014.

To receive the bonus in 2009 and 2010, physicians must:

• Have a qualified e-prescribing system. Go to CMS-recommended www.surescripts.com to compare these systems and find one to fit your practice. E-prescribing readiness assessment programs are also available from an AAFP partner, the Center for Improving Medication Managment, or other vendors such as ePrescribe Florida.
• Report use of e-prescribing, measure 125 of the 2008 PQRI initiative, by using these guidelines.
• Add the appropriate e-prescribing reporting code on Medicare claims for the codes below.

CMS representatives expressed their hope that widespread adoption of e-prescribing systems will streamline the prescribing process for doctors, patients and pharmacists, saving time and money. However, some detractors argue that challenges still exist, such as a lack of standardization and a persistence of keystroke errors that still require pharmacist-physician verification.

TAFP will provide more resources and information on e-prescribing as they become available, including a list of low-cost e-prescribing systems.

CPT Codes

Psychiatric Diagnostic, Evaluative Interview, Psychiatric Therapeutic Procedures
CPT Codes: 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809

General Ophthalmological Services (Eye Codes)
CPT Codes: 92002, 92004, 92012, 92014

Health and Behavior Assessment/Intervention
CPT Codes: 96150, 96151, 96152

Office or Other Outpatient Services
CPT Codes: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215

Office or Other Outpatient Consultations
CPT Codes: 99241, 99242, 99243, 99244, 99245

Cervical or vaginal cancer screening; pelvic and clinical breast examination
G0101

Diabetes outpatient self-management training services
G0108, G0109

Measure Codes

G8443: All prescriptions created during the encounter were generated using a qualified e-Prescribing system

OR

G8445: No prescriptions were generated during the encounter. Provider does have access to a qualified e-Prescribing system

OR

G8446: Some or all prescriptions generated during the encounter were handwritten or phoned in due to one of the following: required by state law, patient request, or qualified e-Prescribing system being temporarily inoperable [Emphasis Added]