What's Next for eRx and What Your Providers Need to do Now

The buzzer has sounded.

All “eligible professionals” who did not prove themselves to be “successful electronic prescribers” during January 1st through June 30th of this year are now subject to Medicare payment adjustments (translation: a 1 percent deduction on Medicare Part B reimbursement) come 2012, according to Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

What’s done is done, and whether your providers are left to nurse their wounds or breathe a sigh of relief, there’s always more eRx activity just around the corner. Here’s the latest, for your knowledge.

Comment by July 25th or Forever Hold Your Peace…
As of June 1st of this year, the 2011 eRx Proposed Rule is published in the Federal Register, providing updates to the existing eRx program. Specifics of the updates include modifications to quality measures, provisions for hardship exemption for the aforementioned 2012 payment adjustments, as well as extensions of deadlines for request of hardship exemptions. You may review details at http://ofr.gov/inspection.aspx and select file code CMS-3248-P.
Providers have until July 25th to submit comments to the rule.

Overview of Incentives—and Penalties—for eRx Going Forward
There’s still benefit to get going with eRx in 2011. Providers who prove to be a “successful electronic prescriber” during the first six months of this year, will avoid the penalty for 2012. However, providers must submit an additional 25 Medicare claims by December 31, 2011 to be eligible for the one percent incentive payment this year and to avoid penalty in 2013. As stated above, noncompliant “eligible professionals” will take a one percent deduction from the Medicare Physician Fee Schedule in 2012, 1.5 percent deduction in 2013 and two percent in 2014.

For the CMS’ specifics regarding “eligible professionals,” visit the website at http://iren.es/mDF4jA. An overview of the entire program may be accessed via http://www.cms.gov/ERxIncentive/.

Be sure to Crack the Code - Reporting the eRx G-Code
Successful reporting for the eRx Incentive Program requires a single G-code, a quality-data code adhering to parameters stated in the CMS document viewable at http://iren.es/lOmvNP. This reference offers guidelines for claims-based reporting.

Important to Know: ePrescribing and Meaningful Use
Did you know providers cannot qualify for both Medicare Meaningful Use incentives and electronic prescribing MIPPA incentives?

2011 is the first year that physicians can demonstrate Meaningful Use of a certified electronic health record (EHR) under the American Recovery and Reinvestment Act of 2009 (ARRA). Eligible professionals who meet Meaningful Use can begin to receive up to $44,000 from Medicare or up to $64,000 from Medicaid over five years. Whether Providers seek eRx incentives or focus on Meaningful Use of EHRs, ePrescribing is an essential and important initiative they must adopt. Emdeon offers an EHR Lite solution with integrated eRx functionality for ease of use and seamless system integration.

Emdeon is on the forefront of knowledge acquisition on eRx issues so that we can bring you practical solutions. Contact us anytime for answers to your specific questions or concerns about ePrescribing.

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