Avoiding the Medicare e-Prescribing “Adjustment” (penalty)

1. Avoiding the Medicare e-Prescribing “Adjustment” (penalty)

2. Medicare Reimbursement Adjustment (penalty). • 2012 Medicare Payments docked 1%* • 2013 Medicare Payments docked 1.5% • 2014 Medicare Payments docked 2% *It is still unknown whether or not the -1% 2012 payment adjustment applies to ODs

3. Avoiding Adjustment • Must use approved eRx software as required by Medicare • Must report at least 25 unique eRx events for patients in the denominator of the measure before 12/31/11. (92000 or 99000 exam). • ODs use “Claims-based reporting” of the electronic prescribing measure. Report a successful e-Rx with G-code (G8553) for 2011

4. Avoiding the Medicare e-Prescribing “Adjustment” (penalty) You can get e-Rx credit for re-prescribing an Rx…but you cannot get credit for giving a pharmacy permission to refill an Rx. You can get credit if you successfully e-Rx with your approved e-Rx software, even if an intermediary changes your e-Rx to a Fax.

5. Exemptions and Exceptions • To request an exemption to the eRx Incentive Program and the payment adjustment, there are two “hardship codes” that can be reported via claims should one of the following situations apply, plus an exemption for not having prescribing privileges. • There are also two exceptions

6. Exemptions • G8642 - The eligible professional practices in a rural area without sufficient high speed internetaccess and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.

7. Exemptions • G8643 - The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act

8. New Exemptions The final rule provides additional significant hardship exemption categories for 2011 for the 2012 eRx payment adjustment: (1) eligible professionals who register to participate in the Medicare or Medicaid EHR Incentive Program and adopt certified EHR technology;

9. New Exemptions (2) eligible professionals who are unable to electronically prescribe due to local, state, or federal law or regulation; (3) eligible professionals who have limited prescribing activity; (4) eligible professionals who have insufficient opportunities to report the e-prescribing measure due to limitations of the measure’s denominator.

10. Exceptions • Does not have prescribing privileges. Note: (S)he must report (G8644) at least one time on an eligible claim prior to December 31, 2011; • Does not have at least 100 cases containing an encounter code in the measure denominator (92000 and 99000 exam codes)

11. What to Do? • Go to the CMS e-prescribing web site • Click on “How to get Started” (left column) http://www.cms.gov/ERxIncentive/03_How_To_Get_Started.asp#TopOfPage

12. Screenshots of e-Prescribing • Dr. Jeremy Baumfalk will walk you through e-prescribing using Allscripts

24. e-Prescribing – Start Soon!