Electronic prescribing (e-prescribing) is the transmission of prescription or prescription-related information through electronic media. This transmission takes place between the prescriber, dispenser, pharmacy benefit manager (PBM) or health plan. A computer-generated fax (physician’s system sends prescription electronically to the fax at the pharmacy) does not qualify for the incentive payment.
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized the e-prescribing incentive program under Medicare and the effective date of this program was January 1, 2009. The final rules were released by CMS on November 19, 2008, and may be found in the Federal Register 73 FR 69726 (November 19, 2008)[1].
Medicare’s E-prescribing Incentive Program Payments (the reporting period is January 1 to December 31 of each year). The claims must be submitted no later than February 28 of the following year.
1. 2009 2% incentive payment.
2. 2010 2% incentive payment.
3. 2011 1% incentive payment.
4. 2012 1% incentive payment.
5. 2013 .5% incentive payment.
The percentage incentive is a percent of all estimated Part B allowed charges for the year. Therefore, even though the measure is limited to certain CPT codes and the requirement to be an e-prescriber is based on those codes, the incentive payment is two percent of all estimated Part B allowed charges submitted by the physician. Even claims where no prescription was written will be included in the total that is eligible for the two percent.
Beginning in 2012 and forward, any eligible prescriber that does not e-prescribe will face a reduction in reimbursement. CMS will propose rules in the future regarding the application of this reduction for non-compliance.
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) allows an exception to Stark by permitting health plans, hospitals and medical groups to provide in-kind support to physicians for e-prescribing. MMA also created a safe harbor to protect these entities from prosecution under the anti-kickback statute. The AMA has a guide for HIT donations for reference, as well. [2]
The TMA Legal Department’s Law Guide topic on “Medicare - E-Prescribing Incentive Program” contains detailed information on who is eligible, how to participate in this program, how to submit claims and what the computer system will need to be able to do. Please go to www.medwire.org login, and click on the Legal tab under “Member” at the top of the page. Once you’re on the Legal home page, choose the Law Guide to access the detailed article.
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