CMS E-Prescribing Incentives

As of January 1, 2009, clinicians are eligible for a bonus payment under Medicare if they are e-prescribing and report such on at least 50% of Medicare patients through submitted claims.

Clinicians can receive bonuses of 2% of Medicare allowed charges in 2009 and 2010; 1% in 2011 and 2012; and .5% in 2013.

Beginning in 2012, there will be a penalty for those not e-prescribing, which increases to 2% of Medicare allowed charges in 2014.

CMS has chosen to implement the 2012 penality for not using e-prescribing in a rather controversial way. As the CMS rule currently stands, if by June 30, 2011, you are not using e-prescribing (per CMS definitions) and further, have not submitted ten Medicare claims to CMS which indicate your use of e-prescibing, you will be assessed a 1% penalty on all of your Medicare claims for 2012. CMS asserts that they need significant lead time to implement the systems necessary to apply the penalty to individual physicians.

The AAFP and many other medical specialty societies believe this ruling by CMS activates the e-prescibing penalty one year sooner than it should and overburdens physicians who are planning to become 'meaningful users' of EHR systems in 2011 and 2012. We continue to strongly encourage CMS to reconsider this premature deadline but, so far, have received no indication that they will change the rule noted above.

Please be advised that if you have not implemented a qualified e-prescribing system in your practice by June 30, 2011 and have not submitted ten e-prescribing codes through the Medicare claims process to CMS by June 30, 2011, you will be assessed a 1% penalty on all Medicare reimbursement for 2012.

To be eligible for the incentive, the prescriber must use a qualified system. This can be either a stand0alone e-prescribing application or an integrated part of an electronic health record (EHR) system. In either case, the system must be able to do all of the following:

• Generate a complete active medication list incorporating electronic data received from applicable pharmacies and benefit managers (PBMs), if available.
  
• Select medications, print prescriptions, electronically transmit prescriptions and conduct safety alerts (such as drug-drug interactions).
  
• Provide information related to lower cost, therapeutically appropriate alternatives. (The availability of tiered formulary information would meet this requirement for 2009.)
• Provide information on formulary or tiered formulary medications, patient eligibility and authorization requirements received electronically from the patient's drug plan, if available.