CMS Launches E-Prescribing Incentive Initiative

The Center for Medicare and Medicaid Services (CMS) will begin a new incentive program for eligible professionals who are successful electronic prescribers (E-Prescribers) beginning January 1, 2009. This new incentive program is in addition to the quality reporting incentive program known as the Physician Quality Reporting Initiative (PQRI). The e-prescribing incentive is similar to the PQRI incentive in that reporting periods are one year in length and the incentive is based on the covered professional services furnished by the eligible professional during the reporting year. In addition, MIPPA requires that quality measures that can be reported for purposes of qualifying for the PQRI incentive payment not include e-prescribing measures. Reporting periods are for a calendar year, beginning with calendar year 2009 through 2013.

The e-prescribing incentive percent amount for reporting years 2009 - 2010 is 2.0 percent; for reporting years 2011 - 2012 is 1.0 percent; and for reporting year 2013 it is 0.5 percent. The incentive does not apply to eligible professionals, for the reporting period, if:

1. The Medicare allowed charges for all covered professional services for the codes to which the e-prescribing measure applies are less than 10% of the total of the allowed charges under Medicare Part B for all such covered professional services furnished by the eligible professional.

OR

2. If determined appropriate by the Secretary, the eligible professional does not submit (including both electronically and non-electronically) a sufficient number of prescriptions under Part D.

CMS will describe which incentive limitation (either 1 or 2 above) will apply for the reporting year 2009 in the final 2009 Physician Fee Schedule rule that will be posted in the Federal Register no later than November 15, 2008.

For purposes of qualifying for the incentive, an eligible professional shall be treated as a successful E-Prescriber for a reporting period if the eligible professional meets the requirements under (1) below, or if determined appropriate by the Secretary, the requirement described in (2) below.

1. The eligible professional reported the applicable e-prescribing quality measure (e.g., e-prescribing measure # 125) in at least 50 percent of the cases in which such measure is reportable by the eligible professional during the reporting year. Note: Any updates to e-prescribing quality measures (specifications and/or reporting instructions) will be posted at http://www.cms.hhs.gov/EPrescribing  on the CMS website.

OR

2. The eligible professional electronically submitted a sufficient number of prescriptions (as determined by the Secretary) under Part D during the reporting period.

CMS will describe the criteria (either 1 or 2 above) that will be used to determine a “successful E-Prescriber” for reporting year 2009 in the final 2009 Physician Fee Schedule rule that will be posted in the Federal Register no later than November 15, 2008.

Starting in January, Medicare will pay a 2% bonus to physicians who successfully e-prescribe under Part D. CMS will assess how often and how consistently physicians prescribe electronically to determine whether they qualify. The bonuses will phase down to 1% in 2011 and 0.5% in 2013 before ending. As noted above a final definition of successful e-prescribing will be issued later in November, along with the CPT codes that can be associated with paperless drug orders. For a complete copy of the CMS fact sheet on this issue go to www.cms.hhs.gov/PQRI/Downloads/PQRIEPrescribingFactSheet.pdf  or visit http://www.cms.hhs.gov/EPrescribing