Last Call to Avoid Medicare Penalty
Physicians who have not e-prescribed at least 10 times by June 30 may be penalized (1 percent Medicare Part B) for the 2012 calendar year. The Centers for Medicare & Medicaid Services (CMS) estimates 209,000 physicians and other providers will be penalized.
The penalty increases to 1.5 percent in 2013 for physicians who do not submit 25 e-prescriptions by Dec. 31. Submitting 25 e-prescriptions by Dec. 31 may also qualify you for a 1 percent bonus. (See TMA's 2011 e-prescribing white paper [PDF]).
Have You Not Started E-Prescribing?
Perhaps you're planning on e-prescribing when you purchase an electronic health record (EHR) system, but with only 15 days left until the June 30 deadline, it won't be implemented soon enough!
Other e-prescribing options are available. Follow these steps:
- Select an e-prescribing system. Many Texas physicians are going with standalone systems such as Dr. First by Rcopia and RxNT, priced around $50 per month per physician. A free vendor-sponsored, ad-supported e-prescribing system also is available through the National ePrescribing Patient Safety Initiative. All of these systems meet CMS qualification standards.
- Select your hardware. To install or access a standalone e-prescribing system, you need a computer with an Internet connection.
- Send 10 e-prescriptions. The June 30 deadline requires you to send 10 new e-prescriptions for 10 of your Medicare patients. (See TMA's 2011 e-prescribing white paper [PDF]).
- Report G-code G8553 to Medicare. There is no separate application for the Medicare e-prescribing program; simply report G8553 on your Medicare claim and submit the G-code again with every office visit during which an e-prescription is sent.
10 E-Prescriptions in a Crunch
If you're in a rush to beat the June 30 deadline, you're not alone. Here is what you need to know about Medicare's e-prescribing program:
- CMS counts a successful e-prescription as an "event" as soon as a physician sends an e-prescription to a pharmacy.
- The event counts even if a pharmacy is not capable of accepting e-prescriptions or rejects the e-prescription. (Standalone e-prescribing systems automatically convert to fax if a pharmacy is not capable of receiving e-prescriptions.)
- Whether a patient picks up his or her prescription is not relevant to a successful event.
- A successful event can include over-the-counter prescriptions for vitamins, stool softeners, and Tylenol 3 or other noncontrolled pain relievers.
Looking for On-Site Help With E-Prescribing?
If you are a primary care physician, you may qualify for assistance through a federal grant for technical consulting services for only $300. Specialists interested in receiving services should contact their regional extension center (REC) for pricing information. The Texas RECs provide consulting help with programs like e-prescribing, selecting and implementing EHRs, and reaching meaningful use to earn federal EHR incentives of $44,000 to $63,750 under Medicare and Medicaid. Visit the TMA REC Resource Center for more information.
TMA urged CMS to revise the current e-prescribing penalties, and CMS announced in May proposed changes to the 2011 e-prescribing program by adding possible exemptions for the 2012 penalty. TMA will comment on the proposed rule, again urging CMS to adopt the additional exemptions. The final ruling on additional exemptions is expected by September. Existing program exemptions can be reported now by using a G-code on Medicare claims, including:
- G8642: Physician's practice is in a rural area without high-speed Internet access; and
- G8643: Physician's practice is in an area without sufficient available pharmacies for electronic prescribing.
If you have additional questions about program e-prescribing or program exemptions, email or call the TMA HIT helpline at (800) 880-5720.
RxEvent Improves Patient Safety
Physicians can now report adverse drug events through www.RxEvent.org, a new online service the PDR Network and its partners launched June 14. The service is available to all prescribers via integration into electronic health records (EHRs) and other online services.
Adverse drug event reports submitted to RxEvent.org will be sent to the manufacturer and/or the U.S. Food and Drug Administration (FDA) and will also be held by the patient safety organization PDR Secure, a PDR news release said. Information from PDR Secure "will be used to better understand adverse events and to develop education materials that will increase patient safety and benefit physicians and other clinicians in their use of drugs," the release said.
PDR Network Chief Executive Officer Edward Fotsch, MD, said RxEvent is designed "to improve the convenience of adverse event reporting for physicians, the cost-efficiency for manufacturers, and the quality of information ultimately reported to the FDA." He said studies indicate that health care professionals report as few as one in 10 adverse drug events, largely due to the time-consuming and inefficient processes involved in reporting adverse drug events.
CMS to Sell Medicare Data
Organizations that meet certain qualifications would have access to Medicare data to generate public reports on physicians, hospitals, and other health care professionals under the Availability of Medicare Data for Performance Measurement [PDF] rule the Centers for Medicare & Medicaid Services (CMS) proposed in early June. It is required by the 2010 health system reform bill.
CMS said in a news release it would sell standardized extracts of Medicare claims data from Parts A, B, and D to "qualified entities that have the capacity to process the data accurately and safely." The data could be used only to evaluate provider and supplier performance and generate public reports detailing those results. CMS has not yet specified what groups it is talking about, but officials said they would evaluate an organization's eligibility based on:
- Organizational and governance capabilities;
- Addition of claims data from other sources; and
- Data privacy and security.
Under the proposal, the organizations would share the reports confidentially with physicians before they are released in an attempt to prevent mistakes. Meanwhile, CMS says publicly released reports would include aggregated information only; individual patient and beneficiary information would not be available.
"We believe the sharing of Medicare data with qualified entities through this program and the resulting reports produced by qualified entities would be an important driver of improving quality and reducing costs in Medicare, as well as for the health care system in general," a CMS statement in the proposed rule said. "Additionally, we believe this program would increase the transparency of provider and supplier performance, while ensuring beneficiary privacy."
CMS will accept comments on the proposal until Aug. 8. Instructions for commenting are in the proposed rule.
TMA Announces Member Benefit for PQRS
TMA presents PQRIwizard
, a simple and cost-effective online tool that eligible physicians can use to collect and report quality measure data under the Physician Quality Reporting System
(PQRS), an initiative created by the Centers for Medicare & Medicaid Services (CMS) in 2007.
In 2011, reporting for PQRS (formerly PQRI) will earn physicians 1 percent of their total allowed charges for Medicare Physician Fee Schedule services. Physicians who do not report data to PQRS will see a 1.5-percent cut in their payments in 2015. That penalty increases to 2 percent in 2016 and subsequent years.
PQRIwizard guides you through four easy steps: (1) select your measures, (2) register, (3) enter chart data from 30 Medicare Part B patients, and (4) review and submit. You will answer a series of questions for each patient. PQRIwizard will let you know when your report is complete and ready to submit to CMS.
The tool's Progress Monitor tracks data so that you have continuous feedback on patients. It provides an alert when all submission criteria have been met and data are ready for you to review and submit. The system calculates measures and provides a printable report of measure results in real time.
After CMS reviews and accepts your data, you will receive an incentive payment equal to 1 percent of your total Medicare Part B Physician Fee Schedule charges for all covered services provided during the reporting period. In other words, the incentive covers all payments received from Medicare fee-for-service, not just those that are applied to the services reported.
The TMA discounted fee for PQRIwizard is $250. The tool enables you to participate in the PQRS program without modifying your billing process. On average, 2009 bonus payments for satisfactory reporters in PQRS were $1,956 per eligible professional.
Interested? Then access the PQRIwizard and begin enrolling for your 2011 incentive. For more information, contact the TMA Knowledge Center at (800) 880-7955 or by email.