Tuesday Nov 18, 2014

Providers taking their time to e-prescribe controlled substances

Controlled substances, such as opiates or anabolic steroids, are newcomers to the field of electronic prescribing. The U.S. Drug Enforcement Agency and most states have allowed physicians to e-prescribe Schedule II-V drugs in only the last few years, namely as the technology demonstrated better security.

A new study published in the American Journal of Managed Care(www.ajmc.com) looked at 18 months of activity on the Surescripts Network, one of the larger e-prescription systems in the country (accounting for almost 60 percent of U.S. e-prescription activity). The study found that between July 2012 and December 2013, the number of transmitted prescriptions for controlled substances surged from a little more than 1,500 to more than 52,000. Also during that period, about one third of pharmacies in the system became capable of receiving and processing e-prescriptions for controlled substances.

The going has been much slower on the provider side, with only 1 percent of those using Surescripts able to e-prescribe controlled substances by the end of the study period. The researchers were optimistic, noting that the number of eligible providers was increasing by several hundred a month at the end of the study period. But they did say that physicians, nurses, and other providers may be dragging their feet because they don’t yet entirely trust the technology or didn't see a financial incentive to make the switch from their prescription pad. They may also view the process of getting themselves and their computer systems registered with the proper authorities as extra work. That should change going forward, the authors said, as proponents have claimed e-prescribing could actually help advance pain management by reducing concerns about fraud and abuse.


Posted at 02:30PM Nov 18, 2014 by David Twiddy | Comments [0]

Wednesday Dec 18, 2013

Penalty for unsuccessful e-prescribers coming in 2014

Were you a successful electronic prescriber under either the 2012 or 2013 Medicare Electronic Prescribing (eRx) Incentive Program(www.cms.gov)? If so, congratulations! If not, expect slightly smaller Medicare payments in 2014.

Eligible professionals and group practices (who self-nominated for the 2012 and/or 2013 eRx group practice reporting option) who didn't successfully complete the incentive programs will receive a 2 percent penalty next year. That means they'll receive only 98 percent of the Medicare Part B physician fee schedule allowed charges they would otherwise have received for services provided from Jan. 1–Dec. 31, 2014.

If you do get notified by the Centers for Medicare & Medicaid Services (CMS) that your payments are being cut, you can get a second opinion by requesting an informal review. Complete instructions on how to request an informal review are available in the 2014 eRx Payment Adjustment Informal Review Made Simple educational document(www.cms.gov) on the CMS web site. You should email your eRx informal review request to eRxInformalReview@cms.hhs.gov no later than February 28, 2014.  

For all other questions related to the eRx Incentive Program, CMS asks that you contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or via qnetsupport@sdps.org. They are available Monday through Friday from 7 a.m.–7 p.m. CST.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians


Posted at 01:56PM Dec 18, 2013 by David Twiddy | Comments [0]

Friday Jun 07, 2013

eRx: It's not too late, but just barely

As mentioned in a previous post, June 30 is the end of the six-month reporting period for physicians to avoid having their Medicare Part B fees cut next year under the federal Electronic Prescribing (eRx) Incentive Program.

The 2 percent 2014 eRx payment adjustment, which affects covered professional services on or after Jan. 1, 2014, only applies to certain individual eligible professionals and group practices. The Centers for Medicare and Medicaid Services (CMS) will automatically exclude those who meet the criteria listed in the eRx Incentive Program: 2014 Payment Adjustment Fact Sheet(www.cms.gov).

For everyone else, avoiding the cut requires submitting 10 eRx events via claims between Jan. 1 and June 30, 2013. The requirements for CMS-selected group practices participating in the eRx group practice reporting option (GPRO) are as follows:

•    eRx GPRO of 2-24 eligible professionals – 75 eRx events via claims,
•    eRx GPRO of 25-99 eligible professionals – 625 eRx events via claims,
•    eRx GPRO of 100+ eligible professionals – 2,500 eRx events via claims.

CMS may exempt individual eligible professionals and group practices participating in the eRx GPRO from the payment adjustment if CMS determines that compliance with the requirements for becoming a successful electronic prescriber would result in a significant hardship. The significant hardship categories are also listed in the fact sheet referenced above.

You can submit your significant hardship exemption requests through the Quality Reporting Communication Support Page(www.qualitynet.org) no later than June 30, 2013. Alternatively, significant hardships associated with a G-code may be submitted via the Communication Support Page or on at least one claim between Jan. 1 and June 30, 2013. If submitting a significant hardship G-code via claims, it is not necessary to request the same hardship through the Communication Support Page. The hardship exemptions for achieving meaningful use or demonstrating intent to participate by registering in the Medicare or Medicaid Electronic Health Record Incentive Program by June 30, 2013, will be automatically processed by CMS and therefore will not need to be entered as a hardship exemption request through the Communication Support Page. CMS will review hardship exemption requests on a case-by-case basis, and all decisions on significant hardship exemption requests will be final.

For more information on how to navigate the Communication Support Page, please see the following documents:

•    Quality Reporting Communication Support Page User Guide(www.qualitynet.org),
•    Tips for Using the Quality Reporting Communication Support Page(www.cms.gov).

Additional information and resources are available through the fact sheet and the eRx Incentive Program website(www.cms.gov). If you have questions regarding the eRx Incentive Program or eRx payment adjustments, or if you need assistance submitting a hardship exemption request, please contact the QualityNet Help Desk at 866-288-8912 (TTY 1-877-715-6222) or via qnetsupport@sdps.org. They are available Monday through Friday from 7am-7pm CT.

 – Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians


Posted at 03:26PM Jun 07, 2013 by David Twiddy | Comments [0]

Tuesday Apr 23, 2013

A limited time opportunity on eRx penalties

Time is running out for physicians to avoid having their Medicare Part B fees cut next year under a federal initiative that encourages electronic prescribing.

The Centers for Medicare & Medicaid Services (CMS) has given practices until June 30, 2013, to show that they have met e-prescribing (eRx) requirements during the first six months of this year (or during the 12-month eRx reporting period of Jan. 1, 2012-Dec. 31, 2012) or to request a hardship exemption from the requirements to avoid the 2014 penalty. (CMS calls it a "payment adjustment.")

Practices can also avoid the 2014 penalty if they do one of the following by June 30, 2013:

•    Register to participate in the Medicare or Medicaid Electronic Health Record (EHR) Incentive Program and adopt certified EHR technology; or

•    Attest achievement of meaningful use under the EHR Incentive Program during either the 12-month eRx reporting period (Jan. 1, 2012-Dec. 31, 2012) or the six-month eRx reporting period (Jan. 1, 2013-June 30, 2013).

If you are currently subject to the eRx payment adjustment or have been in the past, you are not alone. CMS reports(www.cms.gov) that 135,931 eligible professionals were subject to the 2012 eRx payment adjustment because they did not qualify for an exemption, meet exclusion criteria for the adjustment, or comply with eRx reporting requirements in the first half of 2011.

The payment adjustment in 2014 will be 2 percent, which means if you are subject to the adjustment, you will only receive 98 percent of your Medicare Part B physician fee schedule amount for covered professional services, assuming you are not subject to any other payment adjustments under Medicare.

On March 1, CMS re-opened the Quality Reporting Communication Support Page(www.qualitynet.org) to allow individual eligible professionals and group practices the opportunity to request a significant hardship exemption for the 2014 eRx payment adjustment. As noted, hardship exemption requests will be accepted through June 30, 2013. After that, you're out of luck. Also, please note this applies only to hardship exemption requests for the 2014 eRx payment adjustment. The reporting period to avoid the 2013 eRx payment adjustment, or to submit hardship exemption requests, has ended.

The following resources are available to assist individual eligible professionals and group practices in submitting their request for a hardship exemption:

Quality Reporting Communication Support Page User Guide(www.qualitynet.org)

Tips for Using the Quality Reporting Communication Support Page(www.cms.gov)

For additional information on the 2014 eRx payment adjustment, including who is subject to the payment adjustment and how to avoid it, please review the 2014 eRx Payment Adjustment Fact Sheet(www.cms.gov).

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians


Posted at 11:50AM Apr 23, 2013 by David Twiddy | Comments [0]

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