May 23, 2012
The half-way mark for 2012 is quickly approaching. And while the month of June traditionally brings weddings, graduations and the start of summer vacations, busy practitioners face an important deadline on June 30, 2012—one that may present an unpleasant surprise when receiving Medicare reimbursements. In case you haven’t been keeping up with this important topic, here are the highlights.
The 2008 Medicare Improvements for Patients and Providers Act (MIPPA) established financial incentives for practices that employ electronic prescribing for Medicare patients and penalties for practices that do not. “Early adopters” who successfully utilized e-prescribing had the opportunity to increase reimbursements up to 2% for total Medicare estimated professional services (Part B) allowable charges. And as of last year, Medicare started assessing penalties for physicians who were not e-prescribing. This year the penalties continue and increase to 1.5%. Penalties increase to 2% in 2014 and continue until prescribers meet successful e-prescribing criteria.
How Do You Avoid Medicare E-prescribing Penalties?
To avoid penalties and receive the incentive payments, providers must submit an electronic prescription for at least 10 Medicare patient encounters using a “qualified e-prescribing system” by June 30, 2012. Group practices reporting as GRPO I or GRPO II practices have to demonstrate that all prescriptions were electronically submitted within this same time period. Only providers who can demonstrate a hardship factor—practicing in a rural area without sufficient high-speed internet access or without available pharmacies to process e-prescriptions, for example—will be exempt.
What designates a “qualified e-prescribing system”?
The system can either include stand-alone software or be integrated into an electronic health record (EHR). A qualified system must be able to do all of the following:
• Generate a complete active medication list (with information from PBMs or
pharmacies, if available)
• Select medications, transmit them electronically using the applicable standards currently in effect for the Part D program (if applicable) and print prescriptions
• Warn the prescriber of possible allergies or drug/drug interactions
• Provide information on lower-cost, therapeutically-appropriate alternatives
• Provide information on formulary or tiered formulary medications, patient eligibility and authorization requirements received electronically from the patient’s drug plan
What Steps Should You Take Now?
The window for 2013 closes on June 30,2012. If you are already e-prescribing, make sure you submit electronic prescriptions during at least 10 different Medicare patient encounters by then. If you have not yet adopted e-prescribing, there is still time to avoid the penalties and receive incentive payments for the practice. But timing is critical. Providers need to sign up now in order to account for the necessary ramp up period involved with any solution. What’s more, depending on a practice caseload, physicians may require a “buffer period” to accrue 10 separate Medicare encounters requiring prescriptions.
Act today to avoid the rush before the June 30th deadline.