Many providers have asked for information regarding the application process for participating in E-Prescribing. In fact, there is not a formal, onetime application. However, a provider (or practice, as the case may be) will not be entitled to a bonus unless he or she consistently represents – in the context of claim submission – that a qualified E-Prescribing system is being utilized during encounters with Medicare patients.

To earn a Medicare bonus, a provider must utilize one of the G-codes set forth to the right with regard to > 50% of all claims (for Medicare patients) that are identified by the codes discussed during our December 9^th, 2008 blog.

As a summary, to earn a Medicare E-Prescribing Bonus, a provider must (1) be a licensed healthcare provider who consistently used a qualified E-Prescribing system during the respective calendar year. Also, (2) at least 10% of said provider’s 2009 Medicare reimbursement must result from the codes identified by Medicare (see, December 9^th blog) and (3) he or she must report an appropriate “G” code with at least 50% of those specified codes.

Disclaimer: The information contained within the MTBC^® Learning Center is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Learning Center does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances

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As previously discussed, there are three main requirements for earning a Medicare E-Prescribing bonus. During the prior blog we considered the first requirement, i.e., the use of a “qualified” E-prescribing system. Today, we will address the second of the three requirements.

In order to qualify for a Medicare bonus, at least 10% of a provider’s (or practice’s, as the case may be) aggregate Medicare reimbursement during the relevant year must come from claims identified by certain procedure codes. In particular, 10% of all the provider’s reimbursements must relate to procedures identified by the following codes:

• New patient, Office: 99201, 99202, 99203, 99204, 99205
• Established patient, Office: 99211, 99212, 99213, 99214, 99215
• Office consults: 99241, 99242, 99243, 99244, 99245
• Psychiatric Diagnostic/Therapeutic: 90801,90802, 90804, 90805, 90806, 90807, 90808, 90809
• Health and Behavior Assessment: 96150, 96151, 96152
• Opthamological New/Established Patient: 92002, 92004, 92012, 92014
• Miscellaneous: G0101, G0108, G0109

We hope that this discussion has been helpful. Our next blog will focus on the third main requirement for earning a Medicare bonus for E-Prescribing.

Disclaimer: The information contained within the MTBC^® Learning Center is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Learning Center does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances

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There are three primary requirements for earning a Medicare E-Prescribing bonus. Today, we will address the first of the three requirements, which is the consistent usage of a “qualified” E-Prescribing system.

A qualified E-Prescribing system is one that:

1. Generates a complete medication list;

2. Allows the prescriber to select medications, transmit
prescriptions electronically using the applicable
standards, and warns the prescriber of possible
undesirable or unsafe situations
(e.g., contraindications; interactions, etc.)

3. Provides information on lower-cost, therapeutically-appropriate alternatives; and

4. Provides information on formulary or tiered formulary medications, patient
eligibility, and authorization requirements received electronically from the
patient’s drug plan.

It is noteworthy that an EMR that simply generates a prescription via facsimile to a pharmacy is not a “qualified” E-prescribing system. Nevertheless, CMS has recently extended its deadline (which had been January 1, 2009) for banning faxed prescriptions to Jan. 1, 2012.

Disclaimer: The information contained within the MTBC^® Learning Center is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Learning Center does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances

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