50 days left to avoid e-prescribing penalties

 

May 12, 2011 – All eligible professionals (EPs) must successfully e-prescribe for Medicare patients ten (10) times for service dates between January 1, 2011 and June 30, 2011, by submitting code G8553 via claims-based reporting, to avoid the one percent (1%) payment adjustment in 2012. 

Even if the EP attests to being a meaningful user of their EHR in 2011 (a program that includes an e-prescribing requirement), they must still separately submit a minimum of 10 e-prescriptions on claims by the end of June.
 
The 1% payment penalty for 2012 will not apply to you if you: 

• Are not a physician (MDs, DOs, or podiatrists), nurse practitioner, or physician assistant as of June 30, 2011 based on the primary taxonomy code in the National Plan and Provider Enumeration System. (NPPES)
• Do not have prescribing privileges. However, if this is the case, you must report code (G8644 – no prescribing privileges) at least one time on an eligible claim prior to June 30, 2011
• Do not have at least 100 Medicare cases containing an eligible CPTcode between service dates January 1 – June 30, 2011. EligibleCPTcodes are:
  • 90801 – 90809 & 90862 – Psychiatric and psychotherapy
  • 92002 – 92014 – General Ophthalmological Services
  • 96150 – 96152 – Health & Behavior assessment
  • 99201 – 99215 – E & M Visit Codes
  • 99304 – 99316 – Nursing Facility Care
  • 99324 – 99337 – Domiciliary, Rest Home or Custodial Care Services
  • 99341 – 99350 – Home Services
  • G0101 – Cervical or vaginal screening, pelvic and clinical breast exam
  • G0108 – G0109 – Diabetes self-management training

For group practices that are participating in eRx GPRO I or GPRO II during 2011, the group practice must become a successful eRx submitter.  Depending on the group’s size, the group practice must report the eRx measure for 75-2,500 unique eRx events for patients with the afore-mentioned CPT codes.

Please check with your Client Manager if you are unsure whether you will meet the e-prescribe claim requirements in order to avoid the payment penalty in 2012.  These claims must be received by Medicare as of July 31, 2011.

Tags: eRx Incentive Program