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Electronic Prescribing

What is it?
What does it mean for my practice?
Am I an eligible professional?
What does my practice need to get started e-prescribing?
What are some additional resources?
Recent News


What is it?
   
Electronic prescribing, or E-prescribing (eRx), is a computer-based way to generate prescriptions through an automated data-entry process. Prescriptions are generated by using e-prescribing software and then transmitted through a cyber-network to participating pharmacies.

E-prescribing is thought to improve patient safety, streamline communication with pharmacists, and reduce medication costs. In addition to diminishing the risk of medication errors and decreasing liability risks, e-prescribing systems will provide medication management through drug utilization review (DUR) programs and give the healthcare professional access to the patient’s most up-to-date medical history. This check and balance system helps to safeguard against improper dosage distribution, adverse reactions, drug contraindications, and will alert the provider if interactions are found. E-prescriptions can also help to reduce or phone calls and call-backs to pharmacies and transmitting patient information via fax.
   
E-prescriptions may also increase patient compliance by streamlining refills requests and authorization processes.


What does it mean for my practice?


The Medicare Modernization Act (MMA) of 2003 initiated the move towards e-prescribing. The MMA established the Voluntary Prescription Drug Benefit Program, which included the requirement for establishment of an electronic prescription drug program. In 2008, the Medicare Improvements for Patients and Providers Act (MIPPA) authorized a new and separate incentive program for eligible professionals who are successful electronic prescribers. 

There is no sign-up or pre-registration to for individual eligible professionals to participate in the eRx Incentive Program. However, there are certain limitations for who can qualify for an eRx incentive payment. First, an eligible professional must have and use a qualified eRx system and report on his or her adoption and use of the eRx system. Second, the eligible professional must meet the criteria for successful electronic prescriber specified by CMS for a particular reporting period. Finally, at least 10% of a successful electronic prescriber's Medicare Part B covered services must be made up of codes that appear in the denominator of the eRx measure.

For 2011 and 2012, eligible professionals who are successful electronic prescribers may qualify to earn an incentive payment equal to 1.0% of the total estimated allowed charges submitted not later than 2 months after the end of the reporting period. For 2013, the incentive payment amount is reduced to 0.5%.

Beginning in 2012, eligible healthcare professionals who are not successful electronic prescribers may be subject to lesser payments or a penalty. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires CMS to subject eligible professionals who are not successful electronic prescribers under the eRx Incentive Program to a payment adjustment, starting in 2012. This payment adjustment applies to all of the eligible professional's Part B-covered professional services under the Medicare Physician Fee Schedule (MPFS). From 2012 through 2014, the payment adjustment will increase with each new reporting period.

On May 28th, 2011, The Center for Medicare and Medicaid Services (CMS) announced it would be more flexible in allowing doctors to phase in e-prescribing technology. Providers who fail to complete at least ten paperless prescriptions using an approved e-prescribing system between January 1 and June 30, 2011 will receive a 1% cut in Medicare reimbursements in 2012, and a 1.5% cut in 2013, and a 2% cut in 2014. The CMS states that physicians can choose from a number of reasons for not complying with this regulation, such as limiting prescribing activity during the six month time frame; or residing in an area where regulations hinder e-prescribing. Despite these justifications, CMS is not retreating from its commitment to a paperless operation; however, it understands that it may take more time for providers to adjust to the new system.

It is not too late to start participating in the 2010 Electronic Prescribing Incentive Program and potentially qualify to receive a full-year incentive payment for 2011. To become a certified electronic prescriber for the purpose of avoiding the 2012 eRx payment adjustment, eligible professionals must report the eRx measure for a minimum number of unique eRx events between January 1, 2011 and June 30, 2011. Eligible professionals may begin reporting the eRx measure at any time throughout the 2011 program year of January 1 through December 31, 2011 to be incentive eligible, but must do so before June 30, 2011 to be exempt from the 2012 payment adjustment.


Am I an eligible professional?

Eligible professionals must have prescribing authority in order to participate in this program. The following professionals are eligible to participate in eRx Incentive Program: (1) Medicare physicians (Doctors of Medicine, Osteopathy, Podiatric Medicine, Optometry, Oral Surgery, Dental Medicine, Chiropractic), (2) Practitioners (Physician Assitant, Nurse Practitioner, Clinical Nurse Specialists, Certified Registered Nurse Anesthetist, Certified Nurse Midwife, Clinical Social Worker, Clinical Psychologist, Registered Dietrician, Nutrition Professional, Audiologists), (3) Therapists (Physical Therapist, Occupational Therapist, Qualified Speech-Language Therapists.


What does my practice need to get started e-prescribing?

 

   1.   Decide whether you wish to choose a stand-alone e-prescription software or a full electronic medical record (EMR) system which includes e-prescribing functionality. (A stand alone system is less costly, less complex, and more quick to implement; however not all stand-alone e-prescribing systems include other patient medical history information, which could impact a prescriber’s medication decisions.)

   2.   Choose an e-prescription software vendor that utilizes a company, which supplies the electronic prescribing network hub or gateway.

   3.   Install an internet connection (preferably high speed).

   4.   Purchase hardware such as a desktop PC, laptop, pocket PC’s, table PC’s, PDA’s utilizing a wire or wireless network.

 
 

What are some additional resources?
   
AMA- A Clincian's Guide to eRx
   
CMS- Overview of eRx Incentive Program

CMS- eRx Incentive Program Fact Sheet

CMS- eRx Incentive Program Quick Reference Chart
   
California Healthcare Foundation- Overview of eRx

EMR Consultant- Basics of eRx


MedPage Today- CMS Eases eRx Rule


Recent News

The Centers for Medicare & Medicaid Services (CMS) would like to remind eligible professionals and group practices participating in the Medicare Electronic Prescribing (eRx) Incentive Program that the deadline to request a hardship exemption for the 2012 eRx payment adjustment is November 1, 2011. For additional information and resources, please visit www.cms.gov/erxincentive on the CMS website.
 

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