Medicare E-prescribing (eRx) Incentive Program:Getting the 2011 Incentive andAvoiding the 2012 Reduction

Mary Patton WheatleySenior SpecialistHealth Care Affairsmwheatley@aamc.org

E-Prescribing Incentive Program•Established in 2008 to promote adoption of e-prescribing •Carrots and sticks approach• Incentives

2011 and 2012: 1% 2013: 0.5%

• Penalties 2012: 1% 2013: 1.5% 2014: 2%

• No eRx penalties after 2014

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MUST REPORT IN FIRST HALF

OF 2011 TO AVOID 2012 PENALTIES

To whom does eRx Incentive/Penalty Apply?• Professionals with at least 10 percent of

Medicare Part B allowed charges (from the fee schedule) from encounters listed in measure denominator• Includes office visits, skilled nursing, home

health, psych, general ophthalmology services, and health and behavior assessments

• Have prescribing privileges (need to report if you do not have them)

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eRx v. Medicare EHR Incentives

Medicare EHR meaningful user is NOT eligible for eRx incentives

BUT• Will face 1% penalty in 2012 if eligible

professional (EP) does not report through claims to the eRx program in first half of 2011

TAKE AWAY…….START

REPORTING eRx NOW TO AVOID

PENALTY !!

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•1% incentive on Part B allowed charges for PFS services during CY2011

•Single lump payment made in mid-2012

•Use data from all of 2011 to determine incentive amount

2011 Incentives

•1% reduction on Part B allowed charges for PFS services during CY2012

•Penalty applied as claims are processed

•Need to know by 1/1/12 who is subject to penalty Use claims from first half of 2011

2012 Penalty

•1.5% reduction on Part B allowed charges for PFS services during CY2013

•Use CY 2011 data to determine who is subject to penalties

•CMS may consider add’l reporting periods

2013 Penalty

What we know … Different criteria for determining incentives v. penalties

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Source: 2011 Physician Fee Schedule (PFS) Final Rule

eRx criteria for individual EPs

Receive 1.0% Incentive Payment in 2011

AVOID 1.0% Penalty in 2012

Reporting period

January – December 2011 January – June 2011

Reporting mechanism

Claims, EHR, Registry Claims only

“Successful e-prescriber”

Report 25 occurrences Report 10 occurrences

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It is possible for an EP to receive a 2011 incentive payment and still be subject to the 2012 payment reduction.

eRx criteria for EPs - contReceive 1.0% Incentive Payment in 2011

AVOID 1.0% Penalty in 2012

Must meet all of the following:1. Meet EP definition2. Use a qualified system3. Be “successful e-prescriber”

- 25 reporting events4. Encounters listed in denominator

>10% of Medicare Part B allowed charges

5. No Medicare EHR Incentives in 2011

All EPs are subject to the penalty unless one of the following apply:1. Not a physician, NP, or PA on

6/30/112. No rx privileges3. < 100 encounters listed in the

denominator4. Encounters listed in denominator

<10% of allowed charges5. Significant hardship6. Be “successful e-prescriber”

- 10 reporting events

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