The e-Rx "Stick" has Arrived - And, Yes, it Applies to Surgeons
From KarenZupko & Associates
If you aren’t e-Prescribing in 2011, then you risk a Medicare reduction in payments of 1.0% in 2012 and 1.5% in 2013. Here’s the catch – CMS is looking at the first six months of 2011 to determine the penalties for 2012 and 2013.
Unfortunately, for many hand surgeons, complying with the e-Prescribing program will be a major challenge. There are two action steps at this point: get on board with this program if it applies to you (meaning you don’t qualify for an exemption) and secondly, write your Congressman if this makes no sense because you aren’t a high prescriber.
Keep in mind that e-Prescribing is part of Meaningful Use – so if you plan to purchase an EMR later, don’t get hit with a penalty for not e-Prescribing in 2011. There are FREE e-prescribing systems out there, so why not practice in 2011, earn an incentive, avoid a penalty in 2012 all before buying an EMR or submitting for Meaningful Use? If no EMR, visit
www.nationalerx.com and learn about FREE e-Prescribing.
Frequently Asked Questions on the e-Rx Penalty
Question: In my practice, I write very few prescriptions. If I do not write 25 prescriptions on Medicare, will I be subject to the penalty?
Answer: As it stands now, in order to avoid the penalty in 2012, you must e-prescribe during 10 E&M visits (denominator codes) during the period January 1 – June 30, 2011. In order to receive the bonus, you have to e-Prescribe during 25 visits during the year.
There are five exemptions from the penalty:
Your denominator codes (E&M visits) do not meet the 10% minimum requirement as stipulated for the incentive (don’t assume, run the report to make absolutely positive).
Denominator Codes
90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109
- You do not have at least 100 claims that contain an encounter code that falls within the denominator codes for the period of time January 1, 2011 to June 30, 2011.
You are not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of June 30, 2011 or you do not have prescribing privileges (you’ll report G8644 to be considered for this exemption.)
You practice in a rural area with limited high speed internet access (you’ll report G8642 to be considered for this hardship).
You practice in an area with limited available pharmacies for electronic prescribing (you’ll report G8643 to be considered for this hardship).
Question: Basically, does this mean I become penalized for not writing prescriptions?
Answer: Unfortunately, as it stands now, yes, you would be penalized. Again, please voice your concerns with your representatives in Congress asking for a fix to this problem.
Question: Are narcotics considered eligible for e-Prescribing?
Answer: The Drug Enforcement Administration’s (DEA) Interim Final Rule (IFR) on electronic prescriptions for controlled substances was published in the Federal Register on March 31, 2010 and went into effect June 1, 2010. Full implementation of these rules in ambulatory care setting is not wide spread. For more information on the requirements for e-Prescribing narcotics visit the DEA website:
http://www.deadiversion.usdoj.gov/ecomm/e_rx/index.html
From a practical standpoint, work with your e-Prescribing vendor or your EMR vendor to enable electronic prescribing of narcotics. Keep in mind that there may be state restrictions as well. State regulations due supersede the DEA rule. We find that many pharmacies will accept Schedule I narcotics, but not Schedule II – V. We must put pressure on the vendors to make this work!
Look at your prescribing of NSAIDs and antibiotics. In order to avoid the penalty, each provider must electronically prescribe (and report) during 10 E&M visits from January 1, 2011 to June 30, 2011. Unfortunately, post op visits (CPT code 99024) do not count.
Question: What is the penalty percentage for not complying?
Answer: The penalty in 2012 is a 1% reduction in your Medicare payments. In 2013, the penalty is a 1.5% reduction of your Medicare payments.
Question: What is the "1%" bonus based on?
Answer: The bonus for successfully e-Prescribing in 2011 (granted that you do not also participate in the EHR incentive for 2011 – you can’t double dip) is 1% of your annual Medicare Allowable Charges (think the 80% that you receive from Medicare plus the 20% you receive either from the patient or their secondary insurance.)
Question: Is e-prescribing bonus and penalty based on the group or per individual basis?
Answer: The bonus and the penalty are calculated on a per provider basis. However, payment is made to the Taxpayer Identification Number (TIN) for the provider, so the payment goes to the group.
Question: What if you are not practicing because of medical leave?
Answer: There is an exemption if you do not have at least 100 claims that contain an encounter code that falls within the denominator codes for the period of time January 1, 2011 to June 30, 2011.
Question: This does not just relate to Medicare patients, correct?
Answer: The incentive and the penalty are Medicare programs. However, many practices discover the benefits of e-Prescribing and do it for all of their patients, not just the Medicare patients.
Author Contact Information
Cheyenne Brinson, MBA, CPA
Consultant and Speaker, KarenZupko and Associates, Inc.
625 N. Michigan Avenue, Suite 2225, Chicago, IL 60611
(312) 642-5616 ext 220
cbrinson@karenzupko.com