Don’t Miss Out on ePrescribing Incentives

By: Kathleen Gaffney, Principal Consultant, Hayes Management Consulting

Medicare is offering incentive payments to eligible providers who use a qualified

system. E-prescribing on at least 25 unique Medicare encounters in 2011 will
qualify a provider for an additional 1% of that year’s Medicare Part B Fee-for-
Service revenue under MIPPA (Medicare Improvements for Patients and Providers
Act). The incentive money would be received in the fall of 2012.

If incentives aren’t enough to get a provider to start using ePrescribing, Medicare

is offering something else to motivate them – penalties! To avoid penalties of 1%
of Medicare revenue in 2012, a provider must report e-prescribing on 10 unique
Medicare encounters between January and June, 2011. To avoid penalties of 1.5%
of Medicare revenue in 2013, a provider must report at least 25 times during the
full 2011 year. Even if a provider meets the 25-prescription minimum and earns
the 2011 incentive, he or she would still be subject to a penalty in 2012 if that e-
prescribing activity occurs only in the second half of the year. So at a minimum, a
provider should ePrescribe 10 times in the first half of the year and 15 times in
the second half.

An organization can determine the amount of incentive money a provider can

earn or the penalties they will pay using the following table:

Year Incentives* Penalties

2011 1% –
2012 1% 1%
2013 0.5% 1.5%
2014 0% 2%
*Percent of provider’s total Medicare
Part B FFS Allowable Charges. Incentives
assume provider does not receive EHR
incentive for that year.

Program Requirements

To participate in the ePrescribing Incentive Program, a provider must use a

“qualified” ePrescribing system. SureScripts certification qualifies an ePrescribing
system. There are two types of systems; a stand-alone system for ePrescribing
only or an electronic health record (EHR) system with ePrescribing functionality.
A provider can also implement e-prescribing before it is fully operational on an
EMR by using a stand-alone system and then transfer the data to the EMR once it
is live.

The provider must be a MD, NP, or PA with prescribing authority. The provider
must have at least 100 encounters with the specified CPT codes - and those
specified CPT codes must be at least 10% of the provider’s total Part B allowed
charges.

Program Reporting

Reporting is simple. Use G-Code 8553 on the Medicare claim to report that “at
least one Rx was generated and transmitted using a qualified ePrescribing system
during the patient encounter.” There are three types of exemptions that a
provider can request for not participating in ePrescribing the provider is in a rural
area with limited high-speed internet access, practicing in an area with limited
pharmacies for ePrescribing, and provider is without prescribing privileges.

Since the MIPPA and ARRA rules do not allow a provider to collect under both
programs during the same year, a provider can maximize the combined revenue
by earning the ePrescribing bonus in 2011, and then participating in Meaningful
Use in 2012. If a provider begins Meaningful Use in 2012, he/she can still qualify
for the full five years of EHR incentives. If a provider isn’t ready to participate in
Meaningful Use until after 2012, he/she can continue collecting ePrescribing
incentives through 2013.

A recommended ePrescribing strategy:

1. If the practice is large, first calculate the incentives and penalties for each
provider. Identify the providers most affected by the incentives and
penalties. Roll out the ePrescribing system based on the findings.

2. Implement a qualified ePrescribing system prior to June 2011. This provides

30 days to ePrescribe for 10 unique Medicare encounters.

3. At a minimum, a provider must ePrescribe 10 times in the first half 2011

and 15 times in the second half.
 4. Begin collecting Meaningful Use incentives in 2012.

For more information check out the following websites:

http://www.ama-assn.org/ama/pub/eprescribing/home.shtml for information

on work flow changes, cost estimators, incentives calculators and more

http://www.nationalerx.com/ for a free ePrescribing system offered by National

ePrescribing Patient Safety Initiative (NEPSI)

http://www.surescripts.com/connect-to-surescripts/certification-overview.aspx
for information about certified ePrescribing systems