Understanding the Medicare e-Prescribing Incentive Program

Do you understand the Medicare e-Prescribing Incentive Program? Don't get this confused with the incentives outlined in ARRA about HITECH. Sorry, let me clarify: The Medicare e-Prescribing Incentive Program is not the same as the recent incentives outlined in the Health Information Technology (HITECH) provisions within the American Recovery and Reinvestment Act (ARRA).

The Medicare e-Prescribing Incentive Program began January 1, 2009 and provides incentives for eligible healthcare professionals who are "successful e-prescribers". We'll define that later. 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. For 2009, e-prescribing incentive amounts will be 2% of the total estimated allowed charges for professional services covered by Medicare Part B and furnished by an eligible professional during the reporting period (one calendar year). 2% may not seem like much, but it can add up quickly.

Previously, there used to be an e-prescribing quality measure that was included in the Physician Quality Reporting Initiative (PQRI). Now, e-prescribing is no longer included in PQRI and it is the quality measure used in the E-prescribing Incentive Program.

One question that often gets asked about the Medicare e-Prescribing Incentive Program is this: "What defines a "qualified' e-prescribing system?" If you're using an EHR that has some type of e-prescribing capability, are you using a "qualified" e-prescribing system?

According to Medicare, there are two types of e-prescribing systems:

• 1) a system for e-prescribing only (a “stand-alone” system), or
• 2) an electronic health record (EHR) system with e-prescribing functionality.

Either of these systems may be used for the incentive program, as long as they are “qualified.” Let's talk about that word now. A qualified system must be able to do the following:

1. Generate a complete medication list that incorporates data from pharmacies and benefit managers (if available)
2. Select medications, transmit prescriptions electronically using the applicable standards, and warn the prescriber of possible undesirable or unsafe situations
   
3. Provide information on lower-cost, therapeutically-appropriate alternatives (for 2009, tiered formulary information, if available, meets this requirement)
   
4. Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan

So, are you using a "qualified" e-prescribing system? If you're not, then you're missing out on some Medicare incentives.