How to Avoid e-Prescribing Incentive Program Penalties


If you have procrastinated on implementing e-prescriptions, you could pay for it. What started as incentives from the Electronic Prescribing (eRx) Incentive Program have quickly turned to penalties from the Centers for Medicare & Medicaid Services (CMS) for those not making the switch.

The good news? There’s still time to qualify for this year’s incentives and avoid penalties in 2012.

The bad news? There’s not much time. Providers have until June 30, 2011 to submit at least 10 electronic prescription claims to CMS to avoid the 1% payment adjustment from the CMS in 2012.

For physicians who do submit their required 10 e-prescription claims, they will receive a 1% payment bonus in 2012. So, those not participating in the eRx plan in 2011 could miss out on a full 2% of the money they might collect from Medicare in 2012.

The penalties increase .5% per year up to 2% in 2014, while the incentives do the exact opposite. The best time to switch to e-prescribing is now to enjoy the incentives and avoid the penalties.

How to Quickly Qualify
One huge advantage physicians have is that joining the eRx Incentive Program is pretty simple for a government initiative. There’s no application or registration necessary, providers simply report an e-prescribing G-code (G8553) on claims for which patients were given an e-prescription.

Before reporting, the CMS recommends asking yourself these three questions to ensure approval:

Question 1: Do I have an eRx system/program and am I routinely using it?
Question 2: Is my system capable of performing the functions of a qualified system as described here in List 1?
Question 3: Do I expect my Medicare Part B Physician Fee Schedule (PFS) charges for the codes in the denominator of the measure (as noted in List 1) to make up at least 10 percent of my total Medicare Part B PFS allowed charges for 2010?

If you can answer, “yes” to those three questions, you should have no problem getting your eRx incentives and avoiding the penalties.

e-Prescription Procrastination
If your practice hasn’t implemented an e-prescribing program, it may be a little more difficult – but not impossible – to avoid the penalty in 2012, and you still have plenty of time to qualify for 2011 incentives through the end of this year.

“There will be some additional cost and increased initial time requirements, but e-prescribing systems are easy to start,” says Francis Guasp, CPC, and Director of Operations at CareCloud. “Most eRx systems come integrated with EMR for free or a small additional fee, or there are stand alone options as well.”

No matter which eRx solution you choose, there’s no time like the present to get started.

Have you implemented an eRx system? Tell us about it.

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