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e-Prescribing: Ten Required by June 30th

Posted on 14. Apr, 2011 by .

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If you have not begun electronic prescribing, you should do so now. Why? On November 19, 2010, Centers for Medicare & Medicaid Services (CMS) announced that if you do not electronically submit at least ten medical prescriptions from January 1, 2011 to June 30, 2011, you will be subject to a 1% adjustment penalty to your 2012 Medicare reimbursements.

The Penalty

The 2012 and 2013 penalties, also known as Medicare payment adjustments, are a function of meeting e-prescribing thresholds in 2011. Providers need to be thinking about actively using e-prescribing now to avoid 2012 and 2013 reimbursement adjustments.

In addition to electronically submitting a minimum of ten prescriptions, you must submit an additional fifteen medical prescriptions electronically between July 1, 2011 and December 31, 2011 to avoid a 1% reduction in 2012. Also if you do not electronically prescribe a minimum of twenty-five medical prescriptions in 2011, you will be subject to a 1.5% Medicare adjustment penalty levied against your 2013 Medicare reimbursements. Your 2012 and 2013 Medicare reimbursements are affected by how you use e-prescribing in 2011.

Can You Avoid The Penalty?

You can avoid the penalty if you are not a physician or you do not have prescribing privileges. You can also avoid the penalty if you do not have at least 100 Medicare patients or 10% of Medicare patient visits during 2011. Finally, you can avoid payment adjustment penalties if you report a significant hardship exemption.

E-Prescribing Incentive Program

If you do e-prescribe and avoid the penalties, in 2011 CMS will pay you a 1% bonus of your total Medicare Part B reimbursements. The incentive is not limited to 1% of only those encounters where a medication has been submitted electronically but to all 2011 Medicare encounters regardless of whether or not a medication has been prescribed electronically. In 2012 and 2013, there will be a 1% and 0.5% e-prescribing bonus.

For specifics of the bonuses, you should read “How to Get Started” in the e-Prescribing section on CMS’s website found here: http://www.cms.gov/ERxIncentive/

E-Prescribing Requirements

E-Prescribing does not require certification like the Electronic Health Record systems. CMS does outline the following capabilities that software must have in order for the e-prescribing system to be useable:

  • Ability to generate a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers if available.
  • Ability to select medications, print prescriptions, electronically transmits prescriptions and conduct alerts.
  • Ability to provide information related to lower costs and therapeutically appropriate alternatives, if any.

E-Prescribing and EHR Certification

You cannot obtain both the e-prescribing incentive and the EHR Certification incentive at the same time. Therefore to maximize your incentive bonuses, you could obtain the e-prescribing bonus in 2011 and file for the EHR incentive beginning in 2012.

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