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November/December 2009

 
Savvy Coder: Coding & Reimbursement
E-Prescribing: How to Earn the 2 Percent Bonus in 2010
By Kim Ross, OCS, CPC, Academy Coding Specialist and Sue Vicchrilli, COT, OCS, Academy Coding Executive
 
 

(PDF 67.9 KB)

How many practices participated this year in the e-prescribing incentive program? In April, a survey of members of the American Academy of Ophthalmic Executives revealed that 43 percent of them were taking advantage of the program. If your practice is in the remaining 57 percent, you may want to consider e-prescribing next year.

What’s New in 2010?

CMS has proposed easing the threshold that you must meet in order to be paid this incentive in 2010. In 2009, you were required to report one of three e-prescribing measures in 50 percent of applicable cases. The new, proposed requirement is that you would need to report one e-prescribing measure at least 25 times during the 2010 reporting period (Jan. 1 to Dec. 31). The proposed threshold takes into consideration the fact that prescriptions are not generated with every patient encounter and that some prescriptions cannot be billed electronically.

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How Much Is the Bonus?

2010 will be the last year that e-prescribers get a 2 percent incentive bonus. The bonus will be 1 percent in 2011 and 2012, and 0.5 percent in 2013.

Two percent of what? Your incentive payment is 2 percent of your total estimated allowed charges for all professional services (clinical, surgical, ancillary) furnished during the reporting period but does not include revenue from your ASC, injectables or optical shop. This incentive is in addition to the 2 percent PQRI incentive payment. You must have 10 percent of your revenue from Evaluation & Management and/or Eye Codes. Beginning in 2012, physicians who have not made the leap to e-prescribing will see a percentage reduction in their Medicare physician fee schedule payment.

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How Do You Get Started?

You must have a qualified e-prescribing system. The system can be a standalone system or one that is integrated with your electronic health record (EHR) system. The majority of AAOE members currently have standalone e-prescribing systems.

To be considered qualified, a system must be able to:

  1. Generate a medication list (with information from pharmacy benefit managers or pharmacies, if available).
     
  2. Select medications, transmit prescriptions electronically using the applicable standards, and warn the prescriber of possible undesirable or unsafe situations, such as drug-drug interactions, inappropriate dose or allergy concerns.
     
  3. Provide information on lower-cost, therapeutically appropriate alternatives, if any are available.
     
  4. Provide information on formulary or tiered formulary medications, patient eligibility and authorization requirements. The system must have received this information electronically from the patient’s drug plan.

There is no sign-up or preregistration to participate in CMS’ e-prescribing incentive program. Just start reporting.

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Learn More Online

The Academy and AAOE are pleased to announce their participation in a significant outreach program: By visiting www.GetRxConnected.com/aao, you can receive a free Guide to Selecting Technology that will help you assess and select an e-prescribing application for your practice.

The Web site also provides information on e-prescribing/pharmacy connectivity; a listing of pharmacies in your area that can exchange prescription information electronically; and the benefits of e-prescribing for your patients.

FURTHER RESOURCES: For updates and answers to frequently asked questions, visit www.aao.org/e-rx. For CMS information on e-prescribing, visit www.cms.hhs.gov/ERxIncentive or www.cms.hhs.gov/partnerships/downloads/11399.pdf. Got questions? E-mail pqri@aao.org.

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