Incentive Payment For E-Prescription and EHRs

The Stimulus Bill

American Recovery and Reinvestment Act (ARRA)

These payments are in addition to bonus payments under Physician Quality Reporting Initiative (PQRI).

Table 1: Incentive Payment For E-Prescription and EHRs

Year When Payments Begin

Percent of Medicare Part B Schedule Fee For e-prescription

Total Payments Receive for Meaningful HER use

2009

+2%

 

2010

+2%

 

2011

+1%

$44,000 over 5 years

2012

+1%

$44,000 over 5 years

2013

+.5%

$39,000 over 4 years

2014

 

$24,000 over 3 years

Note: If physician is receiving HER incentive payments, cannot concurrently receive the e-prescribing bonus as well.

Table 2: Penalties for not adopting E-Prescribing and EHRs

Year When Penalties Begin

Percent of Medicare Part B Schedule Fee For Not  e-prescription

 Percent of Medicare Part B Schedule Fees for no HER

2012

-1%

 

2013

-1.5%

 

2014

-2%

 

2015

 

-1%

2016

 

-2%

2017

 

-3%

2018 and beyond

 

Could be increased upto 5%


You do not have to register to participate in this incentive program. Eligible professional who successfully report the e-prescribing measure in 2009 may be eligible to receive an incentive payment equal to 2% of all their Medicare Part B (Free-for-service, or FFS) allowed charges for services furnished during the reporting period.

The 2009 Reporting Period is January 1, 2009 through December 31, 2009 This measure can only be reported using the Medicare claims process.

Table3: What is a Qualified E-prescribing system?

A qualified system is an e-prescribing system or program that is able to perform the following task:

  • Generate a complete active medication list using electronic data received from applicable pharmacies and pharmacies benefit manage (PBM), if available.
  • Allows eligible professionals to select medications, print prescription electronic and conducts a ll alerts. Alerts include automated prompts that offer information on the drug being prescribed and warn the prescriber of possible undesirable or unsafe situations such as potentially inappropriate dose or route of administration of the drug, drug-drug interaction, allergy concerned or warninigs/cautions.
  • Providers information on lower cost therapeutically appropriate alternatives, if any. For 2009, a system that can receive tiered formulary information, if available, from thw PBM would satisfy this requirement.
  • Providers information on formulary or tiered formulary medications, patient eligibility and authorization requirements received electronically from the patient drug plan (if available)
  • In addition to the system functionalities mentioned above, the system or program should meet the Part D specifications for messaging that will be implemented on April 1, 2009. For more information about the new Part D requirements, please see http://www.regulations.gov and search from Part D prescription

Table 4: E-Prescription Measure Denominator Codes

The following CPT or HCPCS G-codes are included in the denominator of the e-prescribing measure:

90801,90802, 90803, 90804, 90805, 90806, 90807, 90808, 90809, 92002, 92004, 02012, 92014, 96150, 96151, 99152, 99201, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99243, 99243, 99244, G0101, G0108, G0109

 
 
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