Medicare E-prescribing (eRx) Incentive Program: Getting the 2011 Incentive and Avoiding the 2012 Reduction Mary Patton Wheatley Senior Specialist Health.

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Presentation transcript:

Medicare E-prescribing (eRx) Incentive Program: Getting the 2011 Incentive and Avoiding the 2012 Reduction Mary Patton Wheatley Senior Specialist Health Care Affairs

E-Prescribing Incentive Program Established in 2008 to promote adoption of e- prescribing Carrots and sticks approach Incentives 2011 and 2012: 1% 2013: 0.5% Penalties 2012: 1% 2013: 1.5% 2014: 2% No eRx penalties after MUST REPORT IN FIRST HALF OF 2011 TO AVOID 2012 PENALTIES

To whom does eRx Incentive/Penalty Apply? Professionals with at least 10 percent of Medicare Part B allowed charges (from the fee schedule) from encounters listed in measure denominator Includes office visits, skilled nursing, home health, psych, general ophthalmology services, and health and behavior assessments Have prescribing privileges (need to report if you do not have them) 3

eRx v. Medicare EHR Incentives Medicare EHR meaningful user is NOT eligible for eRx incentives BUT Will face 1% penalty in 2012 if eligible professional (EP) does not report through claims to the eRx program in first half of 2011 TAKE AWAY……. START REPORTING eRx NOW TO AVOID PENALTY !! 4

1% incentive on Part B allowed charges for PFS services during CY2011 Single lump payment made in mid-2012 Use data from all of 2011 to determine incentive amount 2011 Incentives 1% reduction on Part B allowed charges for PFS services during CY2012 Penalty applied as claims are processed Need to know by 1/1/12 who is subject to penalty  Use claims from first half of Penalty 1.5% reduction on Part B allowed charges for PFS services during CY2013 Use CY 2011 data to determine who is subject to penalties CMS may consider add’l reporting periods 2013 Penalty What we know … Different criteria for determining incentives v. penalties 5 Source: 2011 Physician Fee Schedule (PFS) Final Rule

eRx criteria for individual EPs Receive 1.0% Incentive Payment in 2011 AVOID 1.0% Penalty in 2012 Reporting period January – December 2011January – June 2011 Reporting mechanism Claims, EHR, RegistryClaims only “Successful e- prescriber” Report 25 occurrencesReport 10 occurrences 6 It is possible for an EP to receive a 2011 incentive payment and still be subject to the 2012 payment reduction.

eRx criteria for EPs - cont Receive 1.0% Incentive Payment in 2011 AVOID 1.0% Penalty in 2012 Must meet all of the following: 1.Meet EP definition 2.Use a qualified system 3.Be “successful e-prescriber” - 25 reporting events 4.Encounters listed in denominator >10% of Medicare Part B allowed charges 5.No Medicare EHR Incentives in 2011 All EPs are subject to the penalty unless one of the following apply: 1.Not a physician, NP, or PA on 6/30/11 2.No rx privileges 3.< 100 encounters listed in the denominator 4.Encounters listed in denominator <10% of allowed charges 5.Significant hardship 6.Be “successful e-prescriber” - 10 reporting events 7