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If a provider fails to e-prescribe and report it with at least 10 G8553 codes by 30th June 2011, he/she will face a payment adjustment equal to 1% of his/her Medicare Part B allowed charges

G8553 indicates that at least one prescription created during the encounter was generated and transmitted electronically using a qualified e-Rx system.

The E-Rx G-code G8553, which supplies the numerator, must be reported:

• On the claim(s) with the denominator billing code(s) that represent the eligible encounter
• For the same beneficiary
• For the same Date of Service (DOS) as of the claim.
• By the same Eligible Professional that performed the services reflected by denominator codes
• This code should be submitted with a $0 charge (where the system does not allow a $0 charge, a nominal amount can be applied)
• Entire claims with a zero charge will be rejected.

• Psychiatry - 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862
• Ophthalmology - 92002, 92004, 92012, 92014
• Behavioral Health - 96150, 96151, 96152
• Office visits - 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215 Nursing facility care - 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, Assisted Living/Domiciliary - 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337
• Home visits - 99341, 99342, 99343, 99345, 99347, 99348, 99349, 99350
• Pelvic/clinical breast exam - G0101
• Diabetes Self-management training - G0108, G0109

E-Rx line items will be denied for payment, but are passed through the claims processing system to the National Claims History database (NCH), used for E-Rx claims analysis. Eligible professionals will receive a Remittance Advice (RA) which includes a standard remark code (N365). N365 reads: “This procedure code is not payable. It is for reporting/information purposes only.” The N365 remark code does NOT indicate whether the E-Rx G-code is accurate for that claim or for the measure the eligible professional is attempting to report. N365 only indicates that the E-Rx G-code passed into NCH.

Yes. Providers will be exempt from the payment adjustment if:

• Occurrences of Applicable CPTs (denominator codes) are less than 100, and/or;
• Applicable CPT (denominator codes) charges are less than 10% of Total Medicare charges
• Hardship codes – The following hardship codes
  1. If a provider does not have access to Hi-speed Internet, he/she needs to report G8642 at-least once before 30th June 2011 to avoid penalty.
  2. If a provider is in an area without sufficient E-Rx pharmacies, he/she needs to report G8643 at-least once before 30th June 2011 to avoid penalty.
  3. If a provider does not have prescribing privileges/rights, he/she needs to report G8446 at-least once before 30th June 2011 to avoid penalty

No. CMS has clearly stated that in order to avoid Medicare’s payment adjustment, eligible providers must report at least 10 G8553 codes before 30th June 2011, irrespective of whether they are participating in EHR-Meaningful use plan or not.