Part B Insider (Multispecialty) Coding Alert

Published on Fri Aug 14, 2009 PDF

Don't let your incentive payments fall through the cracks.

If your practice is one of the many that is gearing up for an e-prescribing bonus, you need all the facts before you get started.

Your e-prescribing incentive payment this year could total two percent of your allowed Part B charges if you have already started e-prescribing (since you need to have used e-prescribing on 50 percent of qualifying services). Plus, you have the potential to earn another two percent in 2010. In 2011 and 2012 you could earn a one percent bonus, followed by a 0.5 percent bonus in 2013. If you aren't e-prescribing by 2012, you'll face penalties from CMS.

Check out these quick tips in our e-prescribing primer to ensure that you're recouping your rightful bonus.

To participate in CMS's e-prescribing incentive program, you must use a qualified system that can do the following four things, says Barbara J. Cobuzzi, MBA, CPC, CENTC,CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions:

• Generate a complete medication list that incorporates data from pharmacies and benefit managers (when available)

• Select medications, transmit prescriptions electronically using the applicable standards, and warn the prescriber of possible undesirable or unsafe situations

• Provide information on lowercost,therapeutically-appropriate alternatives

• Offer information on formulary or tiered medications, patient eligibility, and authorization requirements received electronically from the patient's drug plan.

To report your e-prescribing to Medicare, you'll have to first bill one of the 33 applicable denominator codes for the service (for instance, the E/M office visit codes 99201- 99215 apply to this requirement). In addition, you'll have to bill one of the three e-prescribing G codes (G8443-G8446).

Cobuzzi offers this example: Mrs. Smith sees Dr. Jones twice a year. She has high blood pressure and glaucoma. Dr. Jones e-prescribes medication to treat her conditions. Dr. Jones reports the appropriate office visit code (such as 99214) along with G8443 (Used a qualified e-prescribing system for all of the prescriptions).

When it comes to training, your peers may not be able to coach you on whether their e-script implementation went smoothly, since many of them haven't yet taken the plunge. "It is estimated that only 12 percent of office-based prescribers currently use e-prescribing," Cobuzzi says.

When the time comes to train your staff on how to use the e-prescribing system, your best bet is to gather everyone together.

"We trained our clinicians all at the same time and did not use the service that is offered by the e-prescribing system we use," says Melanie Scott, CPC, PCS, coder with Five Valleys Urology in Missoula, Mont. "The training was fairly easy; the office manager and I reviewed the system and were trained and shared what we had learned with everybody in the office."

Most other practices agree that training all clinicians at the same time is a productive use of the trainer's time. "I will be training all users -- physicians and medical assistants -- at the same time," says Karla M.Westerfield, COPM, business manager with Southeast Wyoming Ear, Nose & Throat Clinic, PC, in Cheyenne, Wyo. "Training by our eprescribing software vendor is expensive, and the training is not that tough."

Don't forget: An important step in your training process is to contact your local pharmacies and ensure that they are ready to receive your eprescriptions. "This can be the difference between success and failure," Cobuzzi says.

Keep in mind: Some practices have implemented e-prescribing without buying a new system, Cobuzzi says. "You can do it very inexpensively with a standalone system, and this is a great way to ease into using a partial electronic record."