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Monday, April 9, 2012

The Medicare Electronic Prescribing Incentive Program and Meaningful Use

I was recently asked by BIDMC clinical leaders to describe the difference between the Medicare Electronic Prescribing Incentive Program and the Meaningful Use Stage 1 core requirement to e-Prescribe.

Some clinicians are receiving Medicare penalties/fee reductions even though they have achieved the much more rigorous Meaningful Use requirements.

The Medicare Electronic Prescribing Incentive Program and Meaningful Use are two separate initiatives with two separate requirements, although both promote the use of electronic prescribing through the use of incentives and payment adjustments.

The Medicare Electronic Prescribing Incentive Program promotes electronic prescribing by requiring that an eligible professional report the electronic prescribing activities using G-codes in billing claims for 10 encounters per year.

The Meaningful Use Stage 1 requirements promote electronic prescribing by requiring that clinicians meet an electronic prescribing objective by electronically prescribing at least 40% of permissible prescriptions.

Beginning 2012, Congress authorized payment adjustments for clinicians who did not become successful electronic prescribers under the Medicare Electronic Prescribing Incentive Program .  The 2011 Medicare Physician Fee Schedule outlined the requirements to avoid the 2012 payment adjustment.   Eligible professionals were required to report the electronic prescribing measure using the G8553 g-code via claims for at least 10 unique visits where the clinician generated an electronic prescription from Jan. 1, 2011 – June 30, 2011.

Since Meaningful Use does not require claims-based reporting of e-prescribing,  it is possible that clinicians could have achieved Meaningful Use but still been subject to the 2012 eRx payment adjustment.

Clinicians cannot receive incentives under both programs, but they can be penalized under the Medicare Electronic Prescribing Incentive Program.   The AMA produced a useful guide to incentives and penalties.

The Medicare Electronic Prescribing program applies to 2013 and 2014 and then will end.   Thus, make sure you enter your G-codes for 10 encounters that included e-prescribing even if you have attested for Meaningful Use.   That way, you'll avoid the penalties.

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