Transcript E-Prescribing Incentives 2009

E-Prescribing 2009
Oncology ERx
AGENDA
What The Regulations Say
 How this Applies In Oncology
 Why ERx is Your Solution
 FAQs
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onPoint Oncology
The Act
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Section 132 of the Medicare Improvements for Patients and Providers Act of 2008
(MIPPA) authorizes a new and separate incentive program for eligible professionals
who are successful electronic prescribers (e-Prescribers) as defined by MIPPA.
This new incentive program removes the e-prescribing measure from PQRI for
2009, and is in addition to the quality reporting incentive program authorized by
Division B of the Tax Relief and Health Care Act of 2006 - Medicare Improvements
and Extension Act of 2006 (MIEA-TRHCA) and known as the Physician Quality
Reporting Initiative (PQRI).
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The e-prescribing incentive is similar to some aspects of the PQRI incentive in that
reporting periods are one year in length and the incentive is based on the covered
professional services furnished by the eligible professional during the reporting year.
However, this new and separate incentive program is exclusive for adopting and
using e-prescribing successfully.
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CMS will describe the criteria that will be used to determine what eligible
professionals the e-Prescribing Incentive will apply to and how "successful ePrescriber" will be defined for 2009, in the final 2009 Physician Fee Schedule rule
that will be posted in the Federal Register no later than November 15, 2008.
onPoint Oncology
What Medicare Calls EPrescribing (2008 PQRI)
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As a qualified system, the program must be able to
perform the following tasks:
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Generate a medication list
Selecting medications, transmitting prescriptions
electronically and conducting safety checks*
Providing information on lower cost alternatives
Providing information on formulary or tiered formulary
medications, patient eligibility and authorization
requirements received electronically from the patient’s
drug plan
• *Safety checks include: automated prompts that offer information on
the drug being prescribed, potential inappropriate dose or route of
administration of the drug, drug-drug interactions, allergy concerns,
and warnings/cautions.
onPoint Oncology
Successful Reporting of the eRx
Measure for 2009
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The measure is intended to be reported on for
EVERY patient visit in the denominator.
Successful reporting is defined as reporting the
measure on at least 50% of eligible patients or
a % of Part D claims to be named later.
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Limitation: CPT codes that make up the denominator
MUST account for at least 10% of the provider’s total
allowed charges for Medicare Part B covered
services or a number of Part D claims to be named
later.
onPoint Oncology
Incentives for Successful electronic
prescribing under MIPPA
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A 2% payment incentive for successful use of eprescribing is available for 2009 & 2010.
In 2011 and 2012 the payment incentive drops
to 1% of covered Medicare Part B charges.
In 2013 the incentive drops to 0.5% of the
covered Medicare Part B charges
onPoint Oncology
Future Penalties for Not
Electronically Prescribing
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Fee reduction is prospective, providers will have to electronically
prescribe by a date to be determined to be sure their fees are not
reduced in 2012. This date will not be before 2010.
Eligible professionals who are not successfully using electronic
prescribing by 2012 will be penalized 1% of their covered Medicare
Part B charges.
 This means that these providers will be paid at 99% for their
covered Medicare Part B fee schedule services.
Limitation applies as for incentives
Hardship exemption on a case-by-case basis to be reviewed
annually.
onPoint Oncology
Future Penalties for Not
Electronically Prescribing
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In 2013 - 1.5% deducted from their
covered Medicare Part B services.
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Professionals will be paid at 98.5% of the
physician fee schedule for covered services.
In 2014 and beyond penalty will increase
to 2%.
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Professionals will receive 98% of the
physician fee schedule for the covered
services they provide.
onPoint Oncology
Part D Information
The Secretary has the authority to change
the requirements for successful EPrescribing in the future.
 The MIPPA legislation allows for future
use of Part D data in lieu of claims-based
reporting by eligible professionals.
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onPoint Oncology
Implementation Schedule for 2009
PQRI and e-Prescriber Incentive
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2009 PQRI including applicable MIPPA
provisions
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Include in 2009 Physician Fee Schedule Rule
– comment period ended 8/29/08
2009 Electronic Prescribing Incentive
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Those relevant to 2009 will be included in
PFS Final Rule or otherwise implemented
onPoint Oncology
Additional Information
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HHS hosted an electronic prescribing
summit in Boston on October 6 & 7.
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To get a copy of the presentation you can go
to this link:
• http://www.e-prescribeconference.com
onPoint Oncology
Coding for E-Prescribing 2009
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You must use a QUALIFIED E-prescribing
system AND
Have an encounter with one of these codes
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90801, 90802, 90803, 90804, 90805, 90806, 90807, 90808, 90809,
92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202,
99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241,
99242, 99243, 99244, 99245, G101, G0108, G0109
onPoint Oncology
Coding for E-prescribing
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Report on all eligible patients:
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G8443--All prescriptions created during the
encounter were generated using an e-prescribing
system.
G8445--No prescriptions were generated during the
encounter. Provider does have access to a qualified
e-prescribing system.
G8446--Provider does have access to a qualified eprescribing system. Some or all prescriptions
generated were printed or phoned in as required by
state regulation, patient request, or pharmacy being
able to receive electronic transmission.
onPoint Oncology
Why is Oncology ERx The
System for My Practice?
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It is the only FREE system specifically for
Oncology practices.
It was developed by an Oncology Practice for
Oncology Practices.
There will be Oncology specific content on the
site---automatic updates on e-prescribing just
for you!
They are committed to developing relationships
for seamless processing.
The system is free and means more money for
you--duh!
onPoint Oncology
FAQs
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Q: Is e-prescribing just one more government
program to make my life miserable?
A: No, e-prescribing, particularly at no cost to
you, has very real benefits such as:
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Less adverse events due to on-line flagging of drug interactions
Real time benefit investigation and eligibility
Provision of lower cost alternatives for your patients
Proof of prescription adherence
Lowering of costs for refill phone calls and prescription
renewals.
onPoint Oncology
FAQs
Q: Why do I need e-prescribing? I fax
prescriptions right now. Isn’t this eprescribing?
 A: No, to get the 2%, you must use a
qualified e-prescribing system. Oncology
ERx is a qualified system.
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onPoint Oncology
FAQs
Q: Does the e-prescribing initiative
include chemo drugs given in our offices?
 A: No, it does not unless the drug is
picked up at the pharmacy…
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onPoint Oncology
FAQs
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Q: Is this system really free? How much would
it cost if I bought one?
A: Industry estimates for the hardware and software costs of a
basic e-prescribing system range from $1,500 to $4,500 per
physician. Estimated costs for advanced systems, having complex
alerts and reminders, are higher—$29,000 per physician in the first
year and $4,000 annually thereafter. MMA authorized grants for eprescribing in 2007 to help defray some of these costs. You are
benefiting from that.
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SOURCE: Health Affairs, 24, no. 5 (2005): 1159-116 doi:
10.1377/hlthaff.24.5.1159
onPoint Oncology
FAQs
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Q: How much will I make if I do e-prescribing in
2009?
A: Every practice is different…but let’s take an
example. The 2%, like PQRI, is based on Part B
SERVICES---not drugs and lab. So, Dr. X ‘s
allowed Medicare Part B PFS payment in 2007
was $300,000 for E/M and $300,000 drug
administration and other stuff. 2% of $600,000
would be $12,000 for Dr. X. But, remember to
calculate by NPI to get bonus by physician.
onPoint Oncology
FAQs
Q: Is the patient portion taken out of the
calculation of the 2%?
 A: No, like PQRI, it is the sum of all
Medicare service-related allowables for
2009.
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onPoint Oncology
FAQS
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Q: How do all of my patients get loaded into this
system? Or, do I have to key them in one-byone?
A: There are three ways for you to get patients
into the system:
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Key punch them in (free).
Upload them from a comma delimited file (free).
Create an interface (a cost depending upon where
the interface occurs).
onPoint Oncology
FAQs
Q: Does the system check for drug
interactions and adverse effects?
 A: Yes, it does do that.
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onPoint Oncology
FAQs
Q: Does it tell you when the patient fills
the prescription?
 A: Yes, it does…this is invaluable when a
patient is taking an expensive cancer
therapy.
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onPoint Oncology
FAQs
Q: Will the system tell you eligibility and
formulary requirements?
 A: Yes, it will do that for all payers on the
system. About 90% of payers are on the
system.
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onPoint Oncology
Your Questions???
To register right now, go to https://www.oncologyerx.com
onPoint Oncology
Contacts
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To schedule a demo webinar, call
866-868-0370, ext 001 or 002
 Or, e-mail me at [email protected]
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onPoint Oncology