The e-prescribing paradox

How can a practice be penalized and receive incentive payments for electronic prescribing at the same time? It defies logic, but there is a way both to avoid penalties and receive the incentives.

While the Medicare Improvements for Patients and Providers Act will impose a 1% penalty for 2012 and a 1.5% payment cut for 2013 for the failure to e-prescribe, another program, the HITECH Act of 2009, created financial incentives to encourage adoption and meaningful use of electronic health records (EHRs).

To avoid Medicare payment cuts in 2012 and 2013, all prescribers must begin e-prescribing by June 2011. Clinicians must e-prescribe 10 times by June 30, 2011 and 25 times by December 2011 and submit G code G8553 on their claims.

If you have a qualified EHR, make sure the prescriptions are being transmitted electronically and not by fax. Also make sure that your system is using the correct G8553 code. Even if you qualify for meaningful use or you receive the e-prescribing bonus, if you do not do it correctly, you can still be penalized.

If you are a paper practice or do not have a fully functional EHR, you will need to have a free-standing e-prescribing solution up and ready by no later than the end of May. When looking for an e-prescribing system, make sure it includes drug-benefit checking, formulary checking, medication history from outside sources, drug-drug and drug-allergy checking, and bi-directional electronic routing with pharmacies. For more information about systems that qualify, see the article “E-prescribing incentives change to penalties on June 30. “

Here's the bottom line: Electronically prescribe using the G8553 code on at least 10 claims before June 30 (we recommend that you do a few more just to be safe). You can add it to your superbill, or use a code for your staff to use so they will know to put it on the claim at the time of posting the charges for the encounter.

Despite the hassles of e-prescribing, it is nonetheless a worthwhile endeavor both for clinicians and patients. Clinicians can access and manage prescription benefit information (eligibility and formulary), review past prescriptions and medical history, and perform drug-drug interaction checking for medications prescribed by you as well as other clinicians. There are efficiencies for the patient as well, including being able to manage refill requests and authorizations electronically. Legibility of prescriptions is no longer an issue and this reduces dispensing errors by providing pharmacists with clear instructions for specific drugs.

For more information on e-prescribing, see AmericanEHR Partners and ACP's practice management center.