Thursday, April 12, 2012

Refresh Your E-Prescribing Knowledge With This Advice

Medical Billing and Coding


Explore these incentives for adopting eRx.

In case your gastroenterologist's practice hasn't by now adopted electronic prescribing (ePrescribing or eRx) system in 2011, then you may be bound by a payment adjustment for Medicare Part B claims in 2012 and the future years. Read on this expert medical billing and coding article to know more about what these adjustments actually are and how you can circumvent them in the coming years and also take advantage from incentives CMS offers for e-prescribing.

If you have not by now implemented the e-prescribing system in 2011 (between Jan.1, 2011 and June 30, 2011) and not claimed for hardship exemptions by the prescribed deadline, then your practice will have to face a 1 percent adjustment in 2012 for all Medicare Part B claims. Your practice will evade the payment adjustments of 1 percent and will be entitled for an incentive of 1 percent of all Medicare Part B payments in case you have filed claims using the electronic prescription code G8553 (Prescription(s) generated and transmitted via a qualified eRx system or a certified EHR system) no less than ten times in the period between Jan.1, 2011 and June 30, 2011.

If you still fail to implement the electronic prescribing system in 2012, your practice might have to face additional payment adjustments of 1.5 percent in the year 2013 and 2 percent in the year 2014.

Medical Billing and Coding Update: You are also eligible for evading payment adjustments for 2013 in case you have made 25 claims using the e-prescribing code G8553 in the above-mentioned period in 2012.

Medical Billing and Coding Tip: Note These Enrollment Guidelines

The list of qualified professionals (EP) involve physicians and other recognized practitioners who fall under the purview of the Medicare Act who have prescribing authority in their scope of practice. Any EP can enroll for the eRx prescribing incentive program for their Medicare Part B claims. You are not required to pre-register to take part in the program. You are required to observe that 10 percent of your Medicare Part B covered claims should make up for codes in the denominator of the eRx measure.

Providers can report the eRx G-code with office visits, eye exams, psychotherapy or certain other services listed in the CMS e-prescribing measure conditions.

To ensure accurate medical coding and billing, you will be required to have a certified eRx system ready to enroll for the eRx prescribing incentive program. You can further check with your system vendor to make certain that the system meets all the requirements for e-prescribing. To meet the requirements for the incentive program, you will need to convey your involvement to CMS through one of the following methods:

  • By submitting G8553 together with the service code on Medicare Part B claims. Keep in mind that the G code on the claim form must be charged $0.00 or if the system does not permit you to place $0.00, you must assign a very small value to it, for instance, $0.01 (this claim will not be paid out).
  • On the other hand, you can submit your claims to a CMS qualified registry that is also partaking in the 2012 Physician Quality Reporting System (PQRS). Though, you must keep in mind that you must also be participating in the PQRS program to select for this system of submitting your claims.
  • In case your practice has a certified electronic health record (EHR) system in place, you can submit your claims right to CMS using the system. Though, you will also have to be participating in the PQRS program to use this system for eRx prescribing.

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