Medicare is introducing an e-prescribing incentive, as authorized

By Loretta Riley,2014-04-15 15:20
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Medicare is introducing an e-prescribing incentive, as authorized

Dear Colleague,

    ; Medicare will pay you for using an approved E-Prescribing system.

    ; Special codes as outlined in this memo need to be attached to your

    ambulatory Medicare claims.

    ; In 2009 and 2010, you can receive 2% extra on ALL of your ambulatory

    Medicare revenue if you participate correctly in this program.

    ; It is confusing and you will need administration assistance to implement this

    with your billing system.

    Medicare is introducing an e-prescribing incentive, as authorized by Section 132 of the Medicare Improvements for Patients and Providers Act of 2008(MIPPA). The e-prescribing incentive is separate from its PQRI program. There is no registration or sign-up required. Basically, you can participate by submitting claims information for the e-prescribing quality measure, as long as you are using a qualified e-prescribing system such as WebOMR or E-Clinical Works. I have attached a document to this email that describes the features that qualify an e-prescribing system. (We have been advised by John Halamka that WebOMR and e-ClinicalWorks meet the requirements.)


    The first step in submitting the e-prescribing incentive program measure is to be aware that when you bill for a service with one of the codes below, you must also include an e-prescribing code. These codes are referred to as the denominator codes.

90801 90808 96150 99204 99215 G0101

    90802 90809 96151 99205 99241 G0108

    90804 92002 96152 99211 99242 G0109

    90805 92004 99201 99212 99243

    90806 92012 99202 99213 99244

    90807 92014 99203 99214 99245

    (There is a document attached to this e-mail that gives descriptions for each of these CPT codes.)


    The second step is to report one of the three G-codes listed below every time you bill for one of the codes listed in Step 1. Any of the three G-codes count toward the e-prescribing incentive.

If You… Report

    Used a qualified e-prescribing system for all of the prescriptions G8443

    Had a qualified e-prescribing system, but didn’t generate any prescriptions G8445

    during this encounter

    Had a qualified e-prescribing system, but prescribed narcotics or other G8446

    controlled substances

    Had a qualified e-prescribing system, and state or Federal law required you G8446

    to phone in or print the prescriptions

Had a qualified e-prescribing system, and the patient asked that you phone in G8446

    or print the prescriptions

    Had a qualified e-prescribing system, and the pharmacy system can’t receive G8446

    electronic transmission

    To get the incentive in 2009, you must report the e-prescribing quality measure on at least 50% of applicable denominator Medicare Part B claims, and the services identified by the codes shown in Step 1 must add up to at least 10% of your total Medicare Part B allowed charges. Medicare will keep track of these minimum thresholds and therefore it behooves you to apply the codes to applicable claims and submit them regardless of whether you think you will meet the minimum thresholds or not. If you don’t meet the minimum thresholds, you won’t get the incentive, but that’s okay. There’s no downside in trying.

    For 2009 and 2010, the e-prescribing incentive will be payment of an additional 2% of your Medicare allowable amount for all Medicare Physician Fee Schedule covered services. For 2011 and 2012, it will be an incremental 1%, and for 2013, .5%. Interestingly, beginning in 2012, Medicare will incorporate a penalty for those physicians that are not successfully using e-prescribing. In 2012, the penalty will be a 1% decrease, which will increase to 1.5% and then 2% in 2013 and 2014 and beyond, respectively. Therefore, with a penalty looming in a few short years, it behooves us to engage in this e-prescribing incentive now.

    Please keep in mind that the 2% incentive that can be earned is based on total allowed payments for all professional services covered by Medicare Part B during each calendar year, not just on the service codes listed in Step 1 above.

    You may want to consider routinely adding the applicable G-code to all of your Medicare claims. Although for the e-prescribing measure, Medicare is only requiring them on certain claims, it may be easier administratively to include the G-code on all claims and will help to ensure that they are on the claims that they need to be on for the e-prescribing incentive. Additionally, as Medicare makes revisions and updates to the codes in Step 1, you will not have to worry about making changes to your billing system various times throughout the year.

    To begin participating, include a G-code on all Medicare claims, or at a minimum on all claims with codes listed in Step 1, for services rendered beginning January 1, 2009. If you have questions, please consult with your practice manager or refer to the CMS website at

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