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A Medicare Cut is Looming for all Physicians in 2012 and 2013

No matter what happens with the SGR, all doctors face Medicare pay cuts in 2012 and 2013. However, these can be avoided if you act soon.

Since 2009, the Centers for Medicare and Medicaid Services has offered an incentive for eligible professionals (EP) to implement and use electronic prescribing (eRx) in order to improve the quality, efficiency and safety of healthcare delivered to beneficiaries. This initiative will continue in 2011 with successful e-prescribers earning a bonus of 1% of their total allowed charges for professional services covered by the Medicare Part B Physician Fee Schedule. However, for the first time, the 2011 eRx program now includes a payment-adjustment or penalty component. EPs who do not implement and use an eRx system in 2011 will be penalized in 2012 and 2013 through a cut to their Medicare payments! You have only until June 30, 2011 to avoid a 1 % cut in your 2012 allowable Physician Fee Schedule billings and until December 31, 2011 to avoid a 1 1/2 percent penalty for 2013 billings! A full description of the 2011 eRx incentive program and related penalties is available at http://www.acponline.org/running_practice/technology/eprescribing/medicare_program_overview.pdf[PDF].

Even if you are planning to participate in the e-prescribing incentive program and/or the EHR incentive program, you can still be liable for the cut. The only way to avoid the 2012 cut is to file Medicare claims that document 10 qualifying e-prescription events prior to June 30, 2011 only a few months from now. While you may plan to meet the incentive requirements by the end of 2011 via claims or any other method, be certain that you successfully file your 10 claims before the end of June.

To avoid the 2013 penalty of 1 % of total allowed charged under Medicare Part B, you will need to file Medicare claims that document 25 qualifying e-prescription events prior to December 31, 2011. Thus, you may want to file the full 25 claims as soon as possible to avoid all eRx related penalties for both 2012 and 2013.

No matter how you are planning to address e-prescribing either this year or in the near future, you want to take steps now to avoid the penalty in 2012 & 2013. One option is to set up and use a free e-prescribing system that will allow you to submit the required e-prescriptions properly and in time. Practices should evaluate this alternative pathway and weigh the potential patient care, workflow and productivity implications against the cost in terms of lost revenues through the e-prescribing penalty. If you decide to take this approach, one option is the free system provided by The National ePrescribing Patient Safety Initiative (NEPSI).* While the use of a service like this does not eliminate the need for significant data entry, it does offer a relatively easy way to test the waters of e-prescribing and avoid the penalty without having to make a financial commitment to a product or service.

In fact you may find that you want something that is more sophisticated or that fits better with your office workflows. In that case, there are many options to choose from. A good tool to review these options is available at http://www.getrxconnected.org/ACP/site.aspx.

Remember, under the current legislation, you must submit the required eRx documentation through claims only to avoid the penalty. This does not stop you from submitting eRx documentation to fulfill the requirements for the eRx incentive through claims, registry of an Electric Health Record (EHR).

* The ACP does not endorse particular products or services, and this description of a way to avoid the e-prescribing penalty should not be viewed as an endorsement of the mentioned products and services. Further, this approach is certainly not a preferred approach for an office considering the implementation of a full-blown e-prescribing or EHR system.

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