Regulations regarding ePrescribing

Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes a new and separate incentive program for individual eligible professionals who are successful electronic prescribers (e-Prescribers) as defined by MIPPA.

This new incentive is separate from and is in addition to the Physician Quality Reporting Initiative (PQRI) program authorized by Division B of the Tax Relief and Health Care Act of 2006. Eligible professionals do not need to participate in PQRI to participate in the E-Prescribing Incentive Program.

Beginning in 2009 and continuing until 2013, Medicare will provide incentive payments to eligible professionals who are successful e-prescribers as defined in MIPPA. Eligible providers who electronically prescribe will receive a 2 percent incentive payment on the Part B billing in 2009 and 2010, 1 percent in 2011 and 2012 and then a .5 percent incentive in 2013. Those not adopting e-prescribing by 2012 will face penalties starting at 1% and will rise to 2% after 2013. If providers take advantage of the ARRA incentives, then they would not continue to receive MIPPA funds after the begin an EMR system. However non-physicin providers (NP's, PA etc.) in the practice can continue to receive MIPPA funds through the end of 2013, since they do not qualify for the ARRA incentives.

As of October 1, 2008 CMS requires that all written Medicaid prescriptions be on a tamper resistant paper. Electronic prescriptions are excluded from this requirement.

What does this mean for you?

If your a provider that bills medicare $400,000 per year in allowable charges, with e-prescribing you can expect to receive an incentive payment in the amount of $8,000 at the 2% incentive rate. That is more than enough to cover the cost of installing the ZipChart e-Prescribing module. And the incentive payment is only half the story. The increased productivity in staffing resources in dependent upon your medicare base of patients, but the availability of medications list for all patients, as well as drug and allergy interactions increased productivity and more importantly quality of care.

Medicare Incentive for Qualified eRx

According to the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, any provider who meets an annual threshold of e-prescribing patients volume will get incentive payments from Medicare which will start at 2 percent for 2009 and 2010, and then drop to 1 percent in 2011 and 2012 and subsequently fall to 0.5 percent in 2013.

However, those providers who are not adopting E-prescribing, their Medicare reimbursements will decrease by 1 percent in 2012, 1.5 percent in 2013 and 2 percent in 2014 and later.

Those providers who are adopting e-prescribing early will be eligible for the following Medicare reimbursements: Providers are adopting e-prescribing by year Receive Medicare reimbursements ( %) 2009 2 2010 2 2011 1 2012 1 2013 0.5

Those providers who are not adopting e-prescribing by 2012, their Medicare reimbursements will decrease as follows: Providers are not adopting e-prescribing by year Medicare reimbursements decrease by (%) 2012 1.0 2013 1.5 2014 2.0 2015 and subsequent years 2.0

A Qualified eRx must be competent enough to performing all of the following functions.

• Generate a complete active medication list
• Select medications, print prescriptions, electronically transmit prescriptions, and conduct all time alerts(safety checks include: automated prompts that offer information on the drug being prescribed, potential inappropriate dose or route of administration, drug-drug interactions, allergy concerns, or warnings or cautions)
• Provide information on lower-cost, therapeutically appropriate alternatives (if any)
• Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient's drug plan (if available)