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Avoiding the Medicare Avoiding the Medicare e-Prescribing “Adjustment” e-Prescribing “Adjustment”

(penalty)(penalty)

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Medicare Reimbursement Medicare Reimbursement Adjustment (penalty).Adjustment (penalty).

2012 Medicare Payments docked 2012 Medicare Payments docked 1%*1%*

2013 Medicare Payments docked 2013 Medicare Payments docked 1.5%1.5%

2014 Medicare Payments docked 2%2014 Medicare Payments docked 2%*It is still unknown whether or not the -1% 2012 payment adjustment applies to ODs

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Avoiding AdjustmentAvoiding Adjustment

Must use approved eRx software as Must use approved eRx software as required by Medicarerequired by Medicare

Must report at least 25 unique eRx events Must report at least 25 unique eRx events for patients in the denominator of the for patients in the denominator of the measure before 12/31/11. (92000 or measure before 12/31/11. (92000 or 99000 exam). 99000 exam).

ODs use “Claims-based reporting” of the ODs use “Claims-based reporting” of the electronic prescribing measure. Report a electronic prescribing measure. Report a successful e-Rx with G-code (G8553) for successful e-Rx with G-code (G8553) for 2011 2011

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Avoiding the Medicare Avoiding the Medicare e-Prescribing “Adjustment” e-Prescribing “Adjustment”

(penalty)(penalty) You can get e-Rx credit for re-prescribing You can get e-Rx credit for re-prescribing an Rx…but you cannot get credit for giving an Rx…but you cannot get credit for giving a pharmacy permission to refill an Rx.a pharmacy permission to refill an Rx.You can get credit if you successfully e-Rx You can get credit if you successfully e-Rx with your approved e-Rx software, even if with your approved e-Rx software, even if an intermediary changes your e-Rx to a an intermediary changes your e-Rx to a Fax. Fax.

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Exemptions and ExceptionsExemptions and Exceptions

To request an To request an exemptionexemption to the eRx to the eRx Incentive Program and the payment Incentive Program and the payment adjustment, there are two “hardship adjustment, there are two “hardship codes” that can be reported via claims codes” that can be reported via claims should one of the following situations should one of the following situations apply, plus an exemption for not having apply, plus an exemption for not having prescribing privileges. prescribing privileges.

There are also two There are also two exceptionsexceptions

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ExemptionsExemptions

G8642 - The eligible professional G8642 - The eligible professional practices in a rural area practices in a rural area without without sufficient high speed internetsufficient high speed internet access access and requests a hardship exemption and requests a hardship exemption from the application of the payment from the application of the payment adjustment under section 1848(a)(5)adjustment under section 1848(a)(5)(A) of the Social Security Act. (A) of the Social Security Act.

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ExemptionsExemptions

G8643 - The eligible professional G8643 - The eligible professional practices in an area practices in an area without sufficient without sufficient available pharmacies for electronic available pharmacies for electronic prescribingprescribing and requests a hardship and requests a hardship exemption from the application of exemption from the application of the payment adjustment under the payment adjustment under section 1848(a)(5)(A) of the Social section 1848(a)(5)(A) of the Social Security Act Security Act

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The final rule provides additional The final rule provides additional significant hardship exemption significant hardship exemption categories for 2011 for the 2012 eRx categories for 2011 for the 2012 eRx payment adjustment:payment adjustment:

(1) eligible professionals who (1) eligible professionals who register register to participate in the Medicare or to participate in the Medicare or Medicaid EHR Incentive Program and Medicaid EHR Incentive Program and adopt certified EHR technologyadopt certified EHR technology;;

New ExemptionsNew Exemptions

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(2) eligible professionals who are unable (2) eligible professionals who are unable to electronically prescribe to electronically prescribe due to local, due to local, state, or federal law or regulationstate, or federal law or regulation; ;

(3) eligible professionals who have (3) eligible professionals who have limited prescribing activitylimited prescribing activity;;

(4) eligible professionals who have (4) eligible professionals who have insufficient opportunities to report the insufficient opportunities to report the e-prescribing measure due to e-prescribing measure due to llimitations of the measure’s imitations of the measure’s denominatordenominator..

New ExemptionsNew Exemptions

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ExExceptionsceptions

Does not have prescribing privilegesDoes not have prescribing privileges. . Note: (S)he must report (G8644) at least Note: (S)he must report (G8644) at least one time on an eligible claim prior to one time on an eligible claim prior to December 31, 2011;December 31, 2011;

Does not have at least 100 cases Does not have at least 100 cases containing an encounter code in the containing an encounter code in the measure denominatormeasure denominator (92000 and (92000 and 99000 exam codes)99000 exam codes)

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What to Do?What to Do?

Go to the CMS e-prescribing web siteGo to the CMS e-prescribing web site Click on “How to get Started” (left Click on “How to get Started” (left

column)column)http://www.cms.gov/ERxIncentive/03_How_To_Get_Starhttp://www.cms.gov/ERxIncentive/03_How_To_Get_Started.asp#TopOfPageted.asp#TopOfPage

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Screenshots of e-PrescribingScreenshots of e-Prescribing

Dr. Jeremy Baumfalk will walk you Dr. Jeremy Baumfalk will walk you through e-prescribing using Allscriptsthrough e-prescribing using Allscripts

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e-Prescribing – Start Soon!e-Prescribing – Start Soon!