Internal Medicine Coding Alert

Published on Fri Jun 05, 2009 PDF

E-prescribers may be up for a bonus.

PQRI is a voluntary individual reporting program which offers an incentive payment to eligible professionals (EPs) satisfactorily reporting data on quality measures for covered Physician Fee Schedule services furnished to Medicare Part B beneficiaries.

In 2009, the incentive is 2 percent of the EPs estimated total Medicare Part B Physician Fee Schedule (PFS) allowed charges. CMS is also working on the first year of the E-Prescribing Incentive Program, in which EPs indicate on their claims through special G codes whether they take advantage of the benefits of a qualified e-prescribing system. It is not too late to participate in the 2009 PQRI and E-Prescribing Incentive Programs, says Michael T. Rapp, MD, JD, FACEP, of CMS.

There is still time to qualify for both the 2009 PQRI and e-prescribing incentives.

To report this measure, a qualifying e-prescribing system must have been adopted by the practice.

According to CMS, a qualified e-prescribing system is one that is capable of all of the following:

" Generate a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers (PBMs) if available

" Select medications, print prescriptions, electronically transmit prescriptions, and conduct all alerts

" Provide 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)

" Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patients drug plan (if available).

The system must employ, for the capabilities listed, the e-prescribing standards adopted by the Secretary for Part D by virtue of the 2003 Medicare Modernization Act (MMA).