APMA News - September 2011 - (Page 34)

IT Consultant By James R. Christina, DPM Medicare Incentive Payment Programs Medicare currently has three incentive programs that eligible providers can participate in to receive additional payments on top of their regular payment for services provided to Medicare patients. The three programs are: 1) the eRx incentive program (an additional payment for being a successful e-prescriber); 2) the Physician Quality Reporting System (PQRS, formerly PQRI, an additional payment for successfully reporting quality measures); and 3) the incentive payment for “meaningful use” (an additional payment for adopting an electronic health record [EHR] program for patient records in your practice). This article will summarize the three payment programs and look at what is proposed for future years based on the proposed physician fee schedule rule just released by Medicare. Let’s start with the basics. You can receive both the PQRS incentive payment and the eRx incentive payment this year or both the PQRS incentive payment and the meaningful use incentive payment, but you cannot get both the eRx incentive payment and the meaningful use incentive payment in the same year. If you qualify for both eRx and meaningful use, you will receive only the meaningful use incentive payment. gin. To avoid the payment reduction, Medicare determined you had to write 10 qualified unique e-prescriptions between January 1 and June 30, 2011. That means you had to submit the G8553 code on 10 claims during the first six months of this year, or you will receive a 1-percent reduction in all of your Medicare Part B claims for 2012. There are some exemptions: • • • Less than 10 percent of your Medicare Part B billings for the first six months of 2011 were represented in the codes in the denominator of the eRx quality measure (essentially E/M visit codes). You had fewer than 100 Medicare patient encounters represented in the denominator of the eRx quality measure. You practice in a rural area with either limited Internet access or limited access to pharmacies that accept eRx (there are “G” codes you need to submit to receive this exemption). eRx Incentive Payment For 2011, the eRx incentive payment is 1 percent of your total fee-for-service Part B Medicare patient payments. Medicare Advantage program patients, Medicare HMO patients, Railroad Medicare patients, etc., are not included in this program. This restriction applies to the PQRS program, as well. To qualify and receive the eRx incentive payment, you must successfully e-prescribe on 25 qualified unique patient encounters between January 1 and December 31, 2011. You must use a “qualified” (not certified) e-prescribing program, and when you submit the bill for an eligible patient encounter in which you successfully sent an eRx, you must include the code G8553 on your claim form. This code indicates to Medicare that the visit included an e-prescription that was generated and transmitted using a qualified eRx program. The only requirement is that you transmitted the eRx—the patient does not have to actually pick up the prescription. eRx for 2011 is also confusing because in 2012, the first payment reductions for not e-prescribing in 2011 will be34 APMA News September 2011 So if you did not get your 10 e-prescriptions in before June 30, are you out of luck? Not necessarily. In the worstcase scenario, you could get in your 25 eRx for the year and get the 1-percent bonus for 2011, which would offset the 1-percent penalty for 2012. Also, if you qualify for an eRx incentive payment this year, you are exempt from the 1.5-percent payment reduction in 2013. Finally, Medicare has published a proposed rule that includes additional exemptions, the primary one being that if you purchase and register a qualified EHR program, you can apply for an exemption. Once these additional exemptions are finalized, APMA will let members know what they have to do to apply for these exemptions. PQRS Originally started in the last six months of 2007 as the Physician Quality Reporting Initiative, the Physician Quality Reporting System has been renamed for 2012 by CMS because funding is now available for an ongoing program. For 2011, PQRS will pay a 1-percent incentive payment of all of your part B Medicare fee-for-service patients if you successfully report quality measures. Most podiatric physicians will

Table of Contents for the Digital Edition of APMA News - September 2011

APMA News - September 2011
President’s Message
Contents
Highlights from the 2011 Annual Scientific Meeting
Residency as a First Step to Parity
Residency Consortium Enhances Podiatric Medical Training
The Value of Building Relationships with Legislators
Reimbursement
Federal Advocacy Forum
IT Consultant
Can They Really Do That?
Members Who Know Media
Technofile
Young Voices
Small Business 101
CPME Update
APMAPAC Chair Report
APMA All Stars
In Short
Worthy of Note
Affiliates Corner
List of Affiliated Organizations
Insurance Advisor
New Members
Death Notices
APMAPAC Update
Bylaws Propositions Due
Development Update
Annual Scientific Meeting Sponsors
Classified Advertising
Dates to Remember
Advertising Index
10 Questions

APMA News - September 2011