E-Prescribing Incentive Program Changes

In July, the Centers for Medicare & Medicaid Services released proposed changes to the e-prescribing incentive program. The goal of the program is to incent prescribers to voluntarily adopt e-prescribing in the early years of the program and later in the program, penalize those who don’t adopt e-prescribing.

Under the program the following codes denote eligible cases for reporting: Patient encounter (CPT or HCPCS): 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, G0101, G0108, G0109.

2009 Quality reporting codes include: G8443: All prescriptions created during the encounter were generated using a qualified e-prescribing system G8446: Provider does have access to a qualified e-prescribing system. Some or all prescriptions generated during the encounter were printed or phoned in as required by state or federal law or regulations, patient request, or pharmacy system being unable to receive electronic transmission; OR because they were for narcotics or other controlled substances. G8445: No prescriptions were generated during the encounter. Provider does have access to a qualified e-prescribing system. Proposed 2010 program changes will eliminate two of these codes (G8445 and G8446).

Changes for Calendar Year 2010 under the proposal include:

--Reduced reporting complexity including:

• Prescribers report an e-prescribing code only when a patient visit resulted in an electronic prescription being placed.
• Prescribers will need to report this code at least 25 times during the reporting period to be considered a successful electronic prescriber.
• Expansion of reporting mechanisms to include registries and qualified EHR products.

--Broaden eligibility by expanding inclusion to professional services furnished in skilled nursing facilities or the home care setting.

• Implement a provision enabling group practices to qualify for an incentive based on a determination at the group practice level, rather than at the individual eligible professional level.  

CMS accepted comments on the proposed rule until August 31, and will respond to all comments in a final rule to be issued by November 1, 2009. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after January 1, 2010.

Written by: Dr. Patrick Yoder is currently employed by Provation, a Wolters Kluwer Health Company, as the Director of Clinical Development for ProVation Order Sets.