Electronic Health Records: ePrescribing

The Centers for Medicare and Medicaid Services offers eligible providers incentive payments for using an electronic prescribing (ePrescribing) system for prescribing to Medicare patients. In 2013, the incentive is equal to 0.5 percent of total Medicare Part B allowed charges.

The CMS ePrescribing program has two reporting periods: 2014 Penalty (January 1 to June 30, 2013) and 2013 incentive (January 1 - December 31, 2013).

How to Get the 2013 Incentive

Eligible professionals need to report 25 separate electronic prescribing events during the reporting period (2013 calendar year) to receive the incentive (successful e-prescribers receive a check in 2014)

To be eligible for the incentive, you must use qualified ePrescribing technology. A qualified ePrescribing system is one that is capable of all of the following:

1. Generating a complete, active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers if available
2. Selecting medications, printing prescriptions, electronically transmitting prescriptions and conducting provider notifications (that is, signals to warn the prescriber of possible undesirable or unsafe situations including potentially inappropriate dose or route of administration of a drug, drug-drug interactions, allergy concerns, or warnings and cautions).  This functionality must be enabled.
3. Providing information related to the availability of lower cost, therapeutically appropriate alternatives (if any). The ability of an electronic prescribing system to receive tiered formulary information, if available, would suffice for this requirement for reporting the electronic prescribing measure during the reporting periods occurring in CYs 2012 and 2013 until this function is more widely available in the marketplace.
4. Providing information on formulary or tiered formulary medications, patient eligibility and authorization requirements received electronically from the patient's drug plan (if available). For reporting periods that occur in CYs 2012 and 2013, CMS will allow eligible professionals to use a system that meets all of the four above criteria OR they may choose to"Certified EHR Technology."

How to Avoid the Penalty in 2014

Eligible professionals need to report 10 separate electronic prescribing events by June 30, 2013 to avoid the 2014 penalty.

Data may be reported in three ways: 1) to CMS via Medicare Part B claims; 2) to a qualified registry; or 3) to CMS via a qualified electronic health record (EHR) product. 

Hardship Categories

Hardship exemption categories include:

• Inability to electronically prescribe due to state, or federal law, or local law or regulation;
• The eligible professional prescribes fewer than 100 prescriptions during a 6–month payment adjustment reporting period;
• The eligible professional practices in a rural area without sufficient high-speed Internet access (G8642); and
• The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing (G8643).
• Eligible professionals who achieve meaningful use during certain eRx timeframes. For the 2013 eRx payment adjustment, this will include any eligible professional who achieved meaningful use during an applicable reporting period in 2011 or 2012 and has attested to this by January 31, 2013.
• Eligible professionals who demonstrate intent to participate in the EHR Incentive Program and adoption of Certified EHR Technology by registering for the EHR Incentive Program by January 31, 2013. To avoid a penalty in 2013, a physician who is demonstrating meaningful use for the first time must register to participate in the EHR meaningful use incentive program by registering for the program between January 2, 2012 and January 31, 2013, and adopt certified EHR technology. Please note: EHR Incentive Program participants must provide their entire EHR Certification Number in the CMS EHR Certification ID field during registration to receive this hardship. If an eligible professional previously registered for the EHR Incentive Program but did not supply the EHR certification Number for their EHR product at that time, and has not since achieved meaningful use, they need to go back and add that piece of information to their registration before January 31, 2013.

Resources

• CMS webpage on e-prescribing measure
• Sample CMS-1500 Electronic Prescribing Example claim form (.pdf)
• Toolset for ePrescribing Implementation in Physician Offices designed by the Agency for Healthcare Research and Quality

Content courtesy of the American Medical Association