Sunday, July 5, 2009

Q&A with Medicare about e-prescribing incentives

Medicare can be so confusing. I'm not even talking about Part D and the donut hole (yummy, I love donuts). The e-prescribing incentives can get a bit confusing, especially if you were used to the e-prescribing quality measure that was included in the Physician Quality Reporting Initiative (PQRI) before Jan 1, 2009. To provide some clarity on this topic, let me do a bit of a "Q&A" with Medicare about the e-prescribing incentives. All this content is directly from the website.

Here's the first question:
"What requirements/qualifications are needed to successfully participate in the new Electronic Prescribing (e-prescribing) Incentive Program?"
To be a successful e-prescriber for the 2009 e-prescribing Incentive Program, an eligible professional must have adopted a qualified e-prescribing system that employs standards adopted by the Secretary for Part D by virtue of the 2003 Medicare Modernization Act (MMA) and is capable of ALL of the following functions:
  • Generating a complete active medication list incorporating electronic data received from applicable pharmacy drug plan(s) if available
  • Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all alerts (defined below)
  • Providing information related to lower cost, therapeutically appropriate alternatives (if any) (the availability of an e-prescribing system to receive tiered formulary information, if available, would meet this requirement for 2009)
  • Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient's drug plan, if available
Two additional criteria must also be met for the incentive program to be a successful e-prescriber and qualify for the incentive: 1) Medicare charges for the e-prescribing measure codes (delineated in the denominator of the measure specification found here) comprise at least 10% of total Medicare Part B allowed charges; and 2) at least 50% of all Medicare Part B patient encounters (denominator-eligible cases) for the e-prescribing measure must be reported during the 2009 reporting period.
Are you ready for a second Q&A? How about this: I'll try to cover 1 key Q&A topic each day over the next few weeks.

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