E-Prescribe in 2011 to Avoid Medicare Penalties in 2012

A penalty begins in 2012 for Medicare physicians who are not e-prescribing.

To avoid penalties (in 2012, 1 percent of Medicare Part B claims), Medicare physicians must report both:  

  1. E-prescribing via claims on at least 10 unique Medicare encounters by June 30, 2011, AND
  2. At least 25 unique e-prescribing Medicare encounters during the full 2011 year to qualify as a “successful subscriber” for the 2011 incentive (1 percent of Medicare Part B claims).

The Centers for Medicare & Medicaid Services (CMS) has offered the Medicare e-prescribing incentive since 2009 as a way to improve efficiency and safety in health care.  In particular, e-prescribing can prevent medication errors that arise from difficulties in reading or understanding handwritten prescriptions. Escalating Medicare penalties for failing to e-prescribe kick in starting in 2012:

Medicare E-Prescribing Program Incentives/Penalties

         

 

2011

2012

2013

Incentive

 

1%

1%

0.5%

Penalty

 

None

1%

1.5%

If you are planning to apply for the Medicare electronic health record (EHR) incentive in 2011, you can’t receive the e-prescribing incentive in the same year. Physicians enrolled in the federal Medicare EHR incentive program can still be penalized in 2012 if they do not report 10 e-prescriptions via the claims method using G-code G8553. Part of the “meaningful use” criteria set for the federal EHR incentives requires e-prescribing. Physicians applying for the Medicaid EHR incentive are still eligible for e-prescribing incentive payments.   

Programs you can participate in simultaneously (PDF).  

  *Physicians participating in Physician Quality Reporting System (PQRS) cannot earn both an e-prescribing incentive and an EHR incentive in the same year if the physician elects to receive his or her EHR incentive payment through Medicare.  Source: Centers for Medicare & Medicaid Services. See the CMS tip sheet (PDF) for more information.

FAQs

Q. What type of encounter will count as an event? 

A. A physician must generate at least one electronic prescription using a qualified system during a patient visit from a set of defined services.  Multiple prescriptions to the same patient will constitute only one event.  

Q. How do I report e-prescribing data?

A. To avoid the penalty in 2012, physicians must report by using G-code G8553 on claims.  The incentive, however, gives physicians three options for reporting data:

1. Claims-based reporting of the e-prescribing measure. Report only one G-code (G8553) for 2011.

2. Registry-based reporting using a “CMS-selected” registry to submit 2011 data to CMS.

3. EHR-based reporting using a “CMS-selected” electronic health record product, submitting 2011 data to CMS.

Visit the CMS "getting started" webpage for more information. CMS also maintains lists of qualified e-prescribing registries and qualified EHR vendors

Are you in need of technical consulting help? The Texas regional extension centers (RECs) support primary care physicians with individualized, on-site services, technical assistance, guidance, and ongoing support. Visit www.texmed.org/rec for more information.

Published March 3, 2011


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