Electronic Prescribing is a prescriber's ability to electronically send an accurate, error-free, and understandable prescription directly to a pharmacy from the point-of-care. It is vitally important to improving the quality of patient care. First included through the Medicare Modernication Act (MMA) in 2003, the final rule was established in 2008, adopting additional standards for use of e-prescribing.

Now, in 2011, eligible providers who participate in the eRx program will receive a one time bonus payment of 1% in 2012. The requirements for being eligible include providers need to adopt a qualified ePrescribing solution and submit at least 25 claims (at least 10 by 6/30/2011) in 2011 using the eRx reporting measure.

Eligible providers who do not participate in the eRx program in 2011 will be hit with a 1% negative reimbursement adjustment on all claims in 2012. Providers must adopt eRx software and submit at least 10 claims with the reporting measure by 6/20/2011. The negative reimbursement adjustment will continue to increase, with a 1.5% negative reimbursement adjustment in 2013, and a 2% negative reimbursement rate thereafter through Medicare.

To report eRx for the Medicare incentives, claims must be filed with a G8553 code. The codes must be reported on the claim representing the eligible encounter for the same beneficiary, date of service, and eligible professional who performed the service. The G-code can only be submitted with a line item charge of zero ($0.00) dollars, not left blank. This code will then be denied for payment, but passed through to the National Claims History database for analysis and tracking purposes. Claims can NOT be resubmitted for the sole purpose of adding or correcting an eRx code, and must be received by February 24, 2012.

If you are an eligible professional, the best way to avoid the eRx payment adjustment is to acquire a qualified system for eRx, such as Azalea℠ eRx. A qualified eRx system is one that can:

• Generate a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers (PBMs), if available.
• Select medications, print prescriptions, electronically transmit prescriptions, and conduct alerts.
• Provide information related to lower cost and therapeutically appropriate alternatives, if any.
• Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient's drug plan, if available.

The adjustment can also be avoided if the eligible professional:

• Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of June 30, 2011 based on the primary taxonomy in NPPES.
• Does not have prescribing privileges.
• Does not have at least 100 cases containing an encounter code needed for eRx.
• Reports the eRx measure for at least 10 unique eRx events for patients.

For more information on the electronic prescribing incentive program, visit http://www.cms.gov/ERxIncentive/01_Overview.asp#TopOfPage

For more information on Azalea℠ eRx software, please Contact Us for more information or call 877-777-7686 to schedule a live demo.