GA-HITEC Lunch and Learn on E-Prescribing by Kathy Whitmire Managing Director HomeTown Health, LLC

1. GA-HITEC Lunch and LearnonE-PrescribingbyKathy WhitmireManaging DirectorHomeTown Health, LLC

2. Lunch and Learn Outcomes • Define E-Prescribing program • Understand incentives and payment adjustments • Utilize e-prescribing toolkit at http://healthit.ahrq.gov/health-it-tools-and-resources/implementation-toolsets-e-prescribing/toolset-e-prescribing • File compliant 1500 eRx Claim to Medicare • Report E-prescribing / eRX measures • Review Physician MU Incentive Program

3. WHY E-Prescribe ???? What goals can be achieved with e prescribing? • Reduce medication errors. • Reduce the time spent on phone calls, faxing, and call-backs to pharmacies. • Automate prescription renewal requests and authorization processes. • Increase patient convenience. • Increase the use of more-affordable medication options. • Reduce prescription drug misuse and abuse. • Attain greater prescriber mobility. • Qualify for incentive payments

4. Define E-Prescribing program • The Electronic Prescribing (eRx) Incentive Program is a reporting program that uses a combination of incentive payments and payment adjustments to encourage electronic prescribing by eligible professionals. • The program provides an incentive payment to practices with eligible professionals (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]) who successfully e-prescribe for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). • 2012 was the first year the program applied a payment adjustment to those eligible professionals who were not successful electronic prescribers on their Medicare Part B services.

5. Incentives and Payment Adjustments The final eRx payment adjustment will be applied during the 2014 calendar year and is a 2.0% adjustment (eligible professional will receive 98% of his/her Medicare Part B PFS amount for covered professional services). The 2013 eRx Incentive Program 6-month reporting period (1/1/13-6/30/13) is the final reporting period to avoid the 2014 eRx payment adjustment. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive/Downloads/2013SE13__eRx2014PaymentAdjustment_032613.pdf

6. Payment Adjustment Exclusions • The eligible professional achieves Meaningful Use under the Medicare or Medicaid EHR Incentive Program during the 12-month eRx reporting period (1/1/12-12/31/12) or the 6-month eRx reporting period (1/1/13-6/30/13) and attests during the 6-month reporting period (1/1/13-6/30/13) • The eligible professional demonstrates intent to participate in the Medicare or Medicaid EHR Incentive Program by registering (providing EHR certification ID) during the 6-month reporting period (1/1/13-6/30/13) and adopting certified EHR technology • The eligible professional submits one of the hardship exemption G-codes via any payable Medicare Part B PFS claim with a date of service during the 6-month eRx reporting period (1/1/13-6/30/13) • The eligible professional requests and CMS approves a hardship exemption via the Physician Quality Reporting Communication Support Page

7. Hardship Exemption • Inability to electronically prescribe due to state, or federal law, or local law or regulation • The eligible professional prescribes fewer than 100 prescriptions during a 6-month payment adjustment reporting period • The eligible professional practices in a rural area without sufficient high-speed Internet access (reportable via claims as G8642) • The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing (reportable via claims as G8643) • Eligible professionals and members within a group practice participating in eRx GPRO who achieve Meaningful Use under the Medicare or Medicaid EHR Incentive Program during the 12-month eRx reporting period (1/1/2012-12/31/2012) or the 6-month eRx reporting period (1/1/2013-6/30/2013) and attest during the 6-month reporting period (1/1/13-6/30/13) • Eligible professionals and members within a group practice participating in eRx GPRO who demonstrate intent to participate in the Medicare or Medicaid EHR Incentive Program during the 6-month reporting period (1/1/13-6/30/13)

8. Payment Adjustment Feedback Report

9. HOW TO ACCESS: Feedback Report • NPI-Level Reports • Eligible professionals who submitted claims as an individual NPI (including sole proprietors who submitted claims under a SSN) can request their individual NPI-level feedback reports through the Communication Support Page available at http://www.qualitynet.org/pqrsunder the “Related Links” section in the upper left-hand corner of the window. Please allow 2-3 days for processing. • Individuals can access the TIN-level report (which includes NPI-level data for all individual eligible professionals under that TIN) through the Portal with IACS login as discussed in the next section. • The Portal is the secured entry point to access the 2014 eRx payment adjustment feedback reports. The report is safely stored online and accessible only to the eligible professional (and those specifically authorized). Eligible professionals will need to obtain an IACS account for an “end user” role in order to access their 2014 eRx payment adjustment feedback reports through the Portal. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive/Downloads/2013SE13__eRx2014PaymentAdjustment_032613.pdf

10. HOW TO ACCESS: Feedback Report http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive/Downloads/2013SE13__eRx2014PaymentAdjustment_032613.pdf

11. POLL QUESTION POLL QUESTION

12. E– Prescribing Tool Kit http://healthit.ahrq.gov/health-it-tools-and-resources/implementation-toolsets-e-prescribing/toolset-e-prescribing

13. File 1500 eRX Claim to Medicare

14. POLL QUESTION POLL QUESTIONS

15. OTHER ADJUSTMENTS/PENALTIES eRX – 2014 – 2% Adjustment 2015 – 2% +? PQRS – 2015 – 1.5% Adjustment EHR - 2015 - 1% Adjustment POTENTIAL 2015 – 4.5% Sequestration + 2% ???

16. PQRS Penalties On the Way The applicable percent for payment adjustments under PQRS are as follows: • 1.5% adjustment in 2015 (eligible professional will receive 98.5% of his/her allowed Medicare Part B PFS amount for covered professional services that would otherwise apply to such services) • 2.0% adjustment in 2016 and subsequent years (eligible professional will receive 98% of his/her allowed Medicare Part B PFS amount for covered professional services that would otherwise apply to such services)

17. PQRI Incentives and Penalties • 2013 PQRS Participation to Avoid the 2015 PQRS Payment Adjustment • Individual Eligible Professionals • 1. Meet the requirements for satisfactorily reporting as defined in the 2013 PQRS measure specifications (same criteria as 2013 PQRS incentive eligibility). • Note: If participating in PQRS through another CMS program (such as the Medicare Shared Savings Program), please check the program’s requirements for information on how to simultaneously report under PQRS and the respective program and avoid the payment adjustment. • 2. Report at least one valid measure via claims, participating registry, or participating/qualified EHR (data submission vendors and direct EHRs) OR one valid measures group via claims or registry, regardless of incentive eligibility. • 3. Elect to participate in the administrative claims reporting mechanism July 15, 2013 through October 15, 2013. Step 1: Register for IACS at https://applications.cms.hhs.gov/, Step 2: Elect administrative claims through the PV PQRS option at https://portal.cms.gov/. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2013MLNSE13__AvoidingPQRSPaymentAdjustment_020113.pdf

18. PQRI Incentives and Penalties

19. IMPORTANT EP DATES in 2013! Key Meaningful Use Dates in 2013 for EPs • Eligible professionals (EPs) participating in the Medicare EHR Incentive Program, mark your calendars for these key dates in 2013: • Jan. 1, 2013: The reporting period began for EPs for calendar year (CY) 2013 on Jan. 1, 2013. This was the earliest date that EPs beginning their first year of participation in the Medicare MU program could launch their 90-day reporting period, and it was the first day of the year-long reporting period required of EPs in subsequent years of participation. • Feb. 28, 2013: EPs pursuing Medicare EHR incentives must register and attest by Feb. 28, 2013, to receive an incentive payment for CY 2012. To get the maximum incentive payment, Medicare EPs must have begun participation by 2012. Therefore, Feb. 28, 2013, is the last day EPs can register and attest to receive an incentive payment for 2012 and be eligible to receive the maximum amount of $44,000. • Oct. 3, 2013: The last day for EPs to begin the 90-day reporting period for CY 2013 is Oct. 3, 2013. • Dec. 31, 2013: The reporting year ends for EPs on Dec. 31, 2013. EPs may still register and attest to receive an incentive payment for CY 2013 through Feb. 28, 2014.

20. 2015 EHR Payment Adjustments Reduction in reimbursement if meaningful use of certified EHR technology is NOT successfully demonstrated • 2015 – 99% of Medicare FFS covered amount • 2016 – 98% of Medicare FFS covered amount • 2017 – 97% of Medicare FFS covered amount • 2018 – if determined, payment adjustment can occur by 1% point each year until payment adjustment reaches 95%

21. URGENT NOTICE PCP RATE INCREASE ATTESTATION DUE BY JULY 31, 2013 http://dch.georgia.gov/sites/dch.georgia.gov/files/related_files/document/ACA_PCP_Rate_Increase_%20DCH_Website_Posting.pdf Increase to Medicare Fee Schedule

22. Resources • CMS Web Site for the Medicare and Medicaid EHR Incentive Program www.cms.gov/EHRIncentivePrograms • eRX - http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/ERxIncentive/Downloads/2013SE13__eRx2014PaymentAdjustment_032613.pdf • Georgia HITEC - http://ga-hitec.org/

23. EDUCATION – GA-HITEC.ORG PROMO CODE - HITEC

24. Q&A The patient should be on the forefront of every decision you make

25. GA Regional Extension Center Your Health IT Expert Resource. Contact us today! www.ga-hitec.org HomeTown Health is the GA-HITEC Sole Hospital Outreach & Education Partner In Partnership with: The Office of the National Coordinator for Health Information Technology (ONC) U.S. Department of Health and Human Services grant 90RC0004/01. IA-HITREC-03/11-219