Since the passage of MIPPA (Medicare Improvements for Patients and Providers Act of 2008), healthcare providers across the country have begun to integrate e-prescribing into their practices. Under the Act, providers who successfully e-prescribe are currently eligible to earn a 2% bonus on their Medicare collections. Moreover, the e-prescribing incentives are structured in such a way that they will continually decrease over the next few years until they eventually become penalties:
|2014 & On
Nonetheless, many practices are still hesitant to make the transition. Though most of these providers would agree that e-prescribing is superior to the traditional pen and paper method, many feel that the incentives offered are insignificant compared to the cost (mostly their time) of implementing e-prescribing in their offices. However, upon closer examination, the requirements for bonus eligibility are not overly stringent or burdensome. Providers might be able to integrate e-prescribing gradually over an extended period of time and still qualify for the bonuses available under MIPPA.
How to Qualify for a Bonus
Pursuant to the guide released by the Centers for Medicare & Medicaid Services (CMS), healthcare providers must do the following to qualify for the 2% Medicare bonus:
1) Obtain an eligible e-prescribing system—one that can:
- Generate a complete medication list incorporating electronic data received from pharmacies and benefit managers.
- Select medications and transmit prescriptions electronically in accordance with applicable federal standards, and only after warning the prescriber of any possible safety issues associated with the drug order.
- Provide information related to the availability of lower-cost, therapeutically appropriate alternatives.
- Provide information on formulary medications, patient eligibility and authorization requirements received electronically from the patient’s drug plan.
2) Report the appropriate combination of codes on Medicare claims.
- The physician must report the appropriate combination of CPT codes and special G-codes on Medicare claims—in order to qualify, the physician must report the appropriate G-codes for at least 50% of the cases in which they apply.
3) E-prescribe enough to qualify for a bonus!
- The physician must submit just 25 e-prescriptions throughout the entire year!
- The services the physician provided that can be linked to an e-prescription must make up at least 10% of the physician’s Medicare charges for the year.
With such minimal requirements, the transition to e-prescribing does not have to happen overnight. Physicians can ease into e-prescribing on their own terms and in their own time, and still take advantage of the bonuses available under MIPPA.
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