Physicians Must E-prescribe by June 30, 2011 or be Subject to Medicare Penalties
In November, the Centers for Medicare & Medicaid Services announced that beginning in 2012, eligible professionals who are not successful electronic prescribers may be subject to a payment adjustment. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the eligible professional is planning to participate in the eRx Incentive Program. The payment adjustment in 2012, with regard to all of the eligible professionals’ Part B-covered professional services, will result in the eligible professional or group practice receiving 99% of the Physician Fee Schedule (PFS) amount that would otherwise apply to such services.

For purposes of determining which eligible professionals or group practices are subject to the payment adjustment in 2012, CMS will analyze claims data from January 1, 2011- June 30, 2011 to determine if the eligible professional has submitted at least 10 electronic prescriptions during the first six months of calendar year 2011. Group practices reporting as a GPRO I or GPRO II in 2011 must report all of their required electronic prescribing events in the first six months of 2011 to avoid the payment adjustment in 2012. Even practices that plan to adopt EHR systems between July and December, 2011 will be subject to Medicare payment reductions in 2012 if the eligible professional has not submitted 10 claims coded for e-prescribing between January and June, 2011.

Coding for E-prescribing or for exemptions from e-prescribing:

  • G8553 - At least one prescription created during the encounter was generated and transmitted electronically using a qualified EHR system. Note: If more than one prescription is generated for a patient during the same visit, then this would count as only ONE instance of E-prescribing.
  • G8642 - The eligible professional practices in a rural area without sufficient high speed internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.
  • 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.
  • G8644 - The eligible professional does not have prescribing privileges.

The Ohio Board of Pharmacy Approved E-prescribing Modules

If your practice does not have a full EHR system capable of generating an e-prescription, you may still meet the Medicare e-prescribing requirements by utilizing a stand-alone e-prescribing module. The following is a list of the e-prescribing modular systems that are approvable by the Ohio Board of Pharmacy:

  • Allscripts eRx, also known as Allscripts eprescribe (This product used to be free; unclear of the current status)
  • NewCrop
  • OnCallData
  • MicroMD

Cyber Access (This product used to be free; unclear of the current status)