E-Prescribing Fundamentals

How to Accomplish E-Prescribing

E-Prescribing may be accomplished through electronic health record reporting or by purchasing a stand-alone system that is capable of all of the following:

• Generate a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers (PBMs) if available.
• Select medications, print prescriptions, electronically transmit prescriptions, and conduct all alerts.
• Provide information related to 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.

The system must employ, for the capabilities listed, the e-Rx standards adopted by the Secretary for Part D by virtue of the 2003 Medicare Modernization Act (MMA).

HCPCS Code G8553

In order to achieve the 0.5 percent incentive payment for all Medicare Part B, Medicare as a secondary payer and Railroad Medicare allowables, less durable medical equipment, or any drug injected, HCPCS code G8553 - At least one prescription created during the encounter was generated and transmitted electronically using a qualified e-Rx system, must be submitted from the office (claims reporting) or through a qualified CMS registry (registry reporting) at least 25 times associated with a billable exam (see list below) with dates of service between Jan. 1 and Dec. 31, 2013.

CPT and HCPCS codes for qualifying exams: 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109

Be sure to confirm that G8553 was successfully received by verifying the remittance advice codes N365 and/or CO93.

Avoid the 2 Percent Payment Adjust in 2014

In order to avoid the 2 percent payment adjust in 2014, at least 10 e-prescriptions must be submitted from your office, not a CMS approved registry, in conjunction with any Part B service (an exam, a test, or a surgical code) with dates of service between now and June 30, 2013.

Be sure to confirm that G8553 was successfully received by verifying the remittance advice codes N365 and/or CO93.

Sample CMS 1500 Form

View a sample CMS 1500 form.