ePrescribing 2011: The Irony and the Ecstasy

The number of different government programs, and the length of the rules that describe how to take advantage of each of them, can be overwhelming. But one thing is eminently clear: the importance of ePrescribing in 2011. There are three compelling reasons to ePrescribe in the coming year:

  1. Physicians can earn a 1% bonus on their 2011 Medicare revenue. Aside from the patient-care and physician-efficiency benefits that ePrescribing offers, ePrescribing on at least 25 unique Medicare encounters in 2011 will qualify a physician for an additional 1% of that year’s Medicare Part B Fee-for-Service revenue under MIPPA (Medicare Improvements for Patients and Providers Act). That money would be received in the fall of the following year.

  2. 2011 ePrescribing activity protects physicians from the Medicare ePrescribing penalties in 2012 and 2013. Odd as it sounds, while bonuses for 2012 and 2013 will be based on successful ePrescribing in each of those years, penalties for those years will be assessed based on 2011 activity. To avoid penalties in 2012, (1% of Medicare revenue), physicians must report ePrescribing on 10 unique Medicare encounters between January and June, 2011. To avoid penalties in 2013 (1.5% of Medicare revenue), physicians must report at least 25 times during the full 2011 year.

  3. ePrescribing is a great way to begin the transition to an EHR, particularly if a physician intends to participate in the EHR incentives program (ARRA). ePrescribing is an integral part of the Meaningful Use requirements and—with the right software—a great way to begin the transition to a digital office.

Based on the above, I offer a few strategies for consideration. The rules, and the interplay between them, have created a number of consequences, that intended or not, can be used by physicians to their financial advantage:

  1. It is important to start ePrescribing early in 2011. Ironically, even if a physician meets the 25-prescription minimum and earns the 2011 incentive, he or she would still be subject to a penalty in 2012 if that ePrescribing activity—no matter how extensive—occurs only in the second half of the year. So at a minimum, ePrescribe 10 times in the first half of the year and 15 times in the second half.

  2. Since the rules (MIPPA and ARRA) do not allow collecting under both programs during the same year, physicians can maximize the combined revenue by earning the ePrescribing bonus in 2011, and waiting to begin participation in Meaningful Use until 2012. Beginning in 2012 still allows a physician to qualify for the full 5 years of EHR incentives ($44,000 as a Medicare provider).

  3. Another irony is that, although ePrescribing is integral to ARRA, it is possible to satisfy the measures for one program and not satisfy the requirements of the other in any particular year. The requirements differ, and the onus is on the physicians to meet each set of rules to qualify for the respective incentives.

As confusing as the above appears, it is actually even more so, because there are also some exceptions. Not surprisingly, there are organizations (MGMA and AMA, for example) actively petitioning the government to reconsider the basis for 2012 and 2013 ePrescribing penalties and asking for harmonization of the MIPAA and ARRA regulations. For further information on the implications for your practice, I invite you to take advantage of the educational resources available through SRSsoft by calling our Government Affairs Department: 201-802-1300 X 1229.

7 thoughts on “ePrescribing 2011: The Irony and the Ecstasy

  1. When speaking to a DEA representative about e-prescribing he informed me that although the DEA has allowed the e-prescribing of Schedule III narcotics since June, 2010 he stated that the computer that you are using to e-prescribe and the computer that is receiving the prescription must both be DEA certified and that as of 11/2010 the DEA has not certified any computers and do not have any plan in the near future to do so. Narcotics are the bulk of prescriptions that are written in our practice since we are an orthopaedic surgeons office so the e-prescribing does not appear to be of benefit to the practice as the incentives will not even cover the cost of application. Do you have any additonal information about this issue.

    [Evan Steele says]
    You are correct that although the DEA rule permitting ePrescribing of controlled substances was technically effective June 1, 2010, there is still a great deal of work to be done on many fronts to make that practice a reality.

    Many orthopaedic practices, (and other physicians, e.g., surgeons and pain management physicians), are faced with the same challenges that you describe in terms of ePrescribing. Unfortunately, the ePrescribing incentives for 2011 and the penalties for 2012 and later will apply unless your physicians each use ePrescribing for the required number of prescriptions for non-controlled substances. There are several exemptions that you should evaluate: 1) if a physician does not have at least 100 claims with the required encounter codes (CPT codes), 2) if the physician’s Medicare Part B revenue from those encounter codes does not comprise at least 10% of his/her total Medicare Part B revenue, 3) if the practice qualifies for one of the 2 hardship codes that relate to rural areas with limited high-speed internet access or areas with limited pharmacies that accept ePrescriptions.

    The good news is that CMS is aware of the situation and is considering creating a third hardship code based on a preponderance of prescriptions being for controlled substances. Until CMS decides otherwise, however, your physicians will have to weigh the cost of implementing ePrescribing software against the value of the Medicare ePrescribing bonus and the cost of future penalties.

  2. So now what happens to the other G codes like G445 or G446?

    [Evan Steele says]
    Beginning with 2010, there is only one G-code for the MIPPA ePrescribing program. A provider reports G-8553 on a Medicare claim to report that “at least one prescription was generated and transmitted using a qualified ePrescribing system during the patient encounter.”

    The codes used for reporting in 2009 were eliminated:
    G-8443: All prescriptions for the encounter were ePrescribed
    G-8445: No prescriptions were generated during the encounter
    G-8446: Various reasons prevented the provider from ePrescribing the Rx

    CMS was somewhat forgiving since some providers were unaware of the changes and continued using the 2009 codes. CMS assured us, just yesterday, that they will consider G-8443 sufficient for documentation of ePrescribing activity on claims submitted through early October 2010.

  3. Does each physician have to have 10 in before June? Also does it have to be a new rx for that patient or can it be a refillable rx?

    [Evan Steele says:]
    The requirement to ePrescribe on 10 Medicare encounters by June 30 is per physician. The prescription can be a renewal of a drug the patient is already taking, as long as a new prescription is generated and transmitted to the pharmacy electronically. (A “refill” on an existing prescription, which does not require a new prescription, does not count.)

    You can find more detailed information on the ePrescribing regulations on the SRS website: http://srssoft.com/medicare-eprescribing-incentives

  4. Many surgeons prescribe medications in the course of post-op visits. If the surgeon e-prescribes a medication in the course of a post – op visits (CPT 99024) is that a qualifying event to count as one of the necessary 10 prescriptions needed before June 30, 2011?

    [Evan Steele says]
    Under the current 2011 MIPPA ePrescribing regulations, prescriptions written in the course of a post-op visit are not counted towards the 10 ePrescriptions needed by June 30, 2011, since CPT code 99024 is not one of the qualifying visit codes.

    There may be good news, however, in that CMS is publishing a Proposed Rule in the Federal Register on June 1st that recognizes this as an issue that may prevent some surgeons from meeting the requirements. The rule would allow physicians to request an exemption from the 2012 penalties based on either of the following two situations:
    1) The bulk of prescribing activity takes place outside of the specified CPT codes (the situation you describe).
    2) The bulk of prescriptions are for controlled substances which cannot be ePrescribed yet.

    If and when this rule becomes final, providers would have until October 1, 2011 to request the above exemptions. CMS will evaluate requests on a case-by-case basis.

  5. Can narcotics be e-prescribed?

    I am getting mixed answers. I’m being told that all narcotics still have to be written on a script pad and then I’m being told that you can send the script electronically.

    [Evan Steele says:]
    Controlled substances cannot be ePrescribed yet.

  6. In follow-up to Nicole’s comment, does anyone know WHEN controlled substances will be able to be ePrescribed?

    Thanks,

    Art

    [Evan Steele says:]
    It will likely be 2012 before ePrescribing of controlled substances becomes a reality for most providers. Surescripts is launching a limited release this summer and a few of the big pharmacy chains will come on line in late 2011 and early 2012; but there remain certification and other requirements that pharmacies, vendors of ePrescribing software, and physicians must meet before EPCS becomes practical on a widespread basis. In addition, it is not just the DEA and federal rules that govern ePrescribing–each state has its own rules, and currently, 34 states prohibit ePrescribing of controlled substances.

  7. What do you need to do to request an exemption?We are orthopdeic surgeons the largest percentage of medicine that we supply is controlled substances so what is the first step we need to do to request an exemption? Thanks.

    [Evan Steele says:]
    Vicki,
    There is nothing you can do yet to request an exemption from the 2012 ePrescribing penalties. The 60-day comment period for the Proposed ePrescribing Rule just ended earlier this week, and the Final Rule is not anticipated until late August after CMS has considered and determined its response to the comments that were submitted. The Proposed Rule identified October 1, 2011 as the deadline for submitting requests. The Final Rule will spell out the exact process for these case-by-case requests, the deadlines, the information that has to be provided, and the provider’s recourse (if any) in the event that his/her request is denied.

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