Medicare: E-Prescribing Can Increase Bonus Payments

The recent Medicare Improvements for Patients and Providers Act (MIPPA) included incentives for providers who utilize electronic prescribing which is known as e-prescribing beginning January 1. The bonus schedule for e-prescribing will be as follows:

• 2% in 2009 and 2010.

• 1% in 2011 and 2012.

• 0.5% in 2013.

The estimated cost for an e-prescribing system is about $3,000 plus the expense of training and periodic maintenance. Bonuses will hinge on submitting claims of not less than 10 percent that have an e-prescribing quality measure as defined by CMS or the minimum number of Part D prescriptions. The agency has not resolved all the technical aspects for earning incentives and how the program will be enforced. CMS views e-prescribing similarly to the Physician Quality Reporting Initiative (PQRI) and since it is expected to improve care and quality.

Other important points to consider:

• E-prescribing systems that are integrated with an electronic health record (HER) system should be certified by the Certification Commission for Healthcare Information Technology (CCHIT).

• E-prescribing systems must be compatible with Medicare Part D e-prescribing standards for transactions.

• Bonus payments will eventually cease for e-prescribing and e-prescribing will be mandatory by 2012 and there are penalties for violators under the MIPPA.For failing to e-prescribe, CMS will reduce payments by the following percentages: 1% in 2012; 1.5% in 2013; 2% in 2014 and beyond.

CMS may offer hardship exemptions under certain circumstances.

NOTE: The 2009 PQRI includes a 2% incentive bonus and coupled with the e-prescribing bonus could result in a 4% increase in payments.