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E-Prescribing

 

  • Electronically Access That Patient's Prescription Benefit: Electronically accessing a patient's prescription benefit information - both formulary and eligibility - allows prescribers to choose medications that are on formulary and are covered by the patient's drug benefit. Prescribers can also choose lower-cost alternatives such as generic drugs. Dispensing pharmacies are less likely to receive prescriptions that require changes based on the patient's drug benefit, which, in turn, reduces unnecessary phone calls from pharmacy staff to physician practices regarding drug coverage.

 

  • With a Patient's Consent, Electronically Access that Patient's Medication History: Electronically accessing a patient's medication history allows prescribers to receive critically important information on their patients' current and past prescriptions and to become better informed about potential medication issues with their patients (e.g., catching potentially harmful drug-to-drug and drug-allergy interactions). Prescribers can use this information to improve safety and quality. And - by understanding the cycle of dispensing related to a prescription - prescribers can gain insight into a patient's medication adherence.

 

  • Electronically Route the Prescription to the Patient's Choice of Pharmacy: Exchanging prescription information electronically between prescribers and pharmacies improves the accuracy of the prescribing process and saves time. Time savings primarily result from reduced pharmacy phone calls and faxes related to prescription renewal authorizations as well as from a reduced need for pharmacy staff to key in prescription data.

E-prescribing supports a shift to a paperless and more informed way for prescribers, payers and pharmacists to make better clinical decisions and improve clinical workflows related to medication management.

  • Improving patient safety and quality of care
  • Reducing time spent on phone calls and call-backs to pharmacies
  • Automating the prescription renewal request and authorization process
  • Increasing patient convenience and medication compliance
  • Improving formulary adherence permits lower cost drug substitutions
  • Allowing greater prescriber mobility
  • Improving drug surveillance/recall ability

 

Click here to see a visual demonstration of how e-prescribing works.

 

E-Prescribing and the Health Information Technology for Economic and Clinical Health (HITECH) Act

The Health Information Technology for Economic and Clinical Health (HITECH) Act is a key component of the American Recovery and Reinvestment Act of 2009 (ARRA). The main goal of the HITECH Act is to encourage the adoption of meaningful use of electronic medical records (EMRs) through incentive payments to physicians and hospitals.

Under the Act, eligible prescribers can receive incentive payments by meeting qualitative and quantitative standards for the 'meaningful use' of a certified EMR starting in 2011. The Act also makes provisions for incentive payments to support the acquisition and use of certified EMR technology for prescribers who see high volumes of Medicaid patients, and makes federal matching funds available for some state Medicaid plans for programs that encourage adoption and use of EMR technology.

E-prescribing is a key component of 'meaningful use'. Prescribers who wish to participate in this program should ensure that their chosen EMR system includes e-prescribing functionality that establishes an electronic connection with payers and pharmacies for Prescription Benefit, Medication History and Prescription Routing services.

The Act also establishes funding and support for the development of state health information exchanges (HIEs), regional extension centers and others to assist prescribers toward becoming meaningful users of this technology and, through this, to help them to qualify for incentive funding when it becomes available.

The Office of the National Coordinator posted a set of frequently asked questions to help health care providers understand and meet requirements for the meaningful use rule.

Additional information on this program can be found on the CMS website at the following link:

http://www.cms.gov/EHRIncentivePrograms/

 

Medicare Electronic Prescribing Incentive Program

Note: The information presented below reflects program details as of December 2009. Please refer to the CMS web site for the latest information about this program.

OVERVIEW:

  • The Medicare Improvements for Patients and Providers Act (MIPPA), passed in July 2008, contains several new authorities and requirements for quality reporting and PQRI for 2009 and beyond.
  • The program establishes both financial incentives for electronically prescribing in many physician practices and penalties for those that do not adopt by a certain threshold date.
  • Those wishing to participate must use a 'qualified' e-prescribing system and report their use of e-prescribing per the requirements of the program
  • Section 132 of MIPAA contains the new electronic prescribing incentive provisions.

 

WHO CAN PARTICIPATE?

Any medical professional defined as 'eligible' by CMS may participate. In general, an eligible professional is one of the following:

  • Physician
  • Physical or occupational therapist
  • Qualified speech-language pathologist
  • Nurse practitioner
  • Physician assistant
  • Clinical nurse specialist
  • Certified registered nurse anesthetist
  • Certified nurse midwife
  • Clinical social worker
  • Clinical psychologist
  • Registered dietitian
  • Nutrition professional
  • Qualified audiologist

 

INCENTIVE PAYMENTS:

Successful e-prescribers can receive incentive payments as follows:
Increase in amount of total allowed charges for covered professional services
(Part B charges)


2009 2.0%
2010 2.0%
2011 1.0%
2012 1.0%
2013 0.5%

For prescribers that do not adopt e-prescribing, penalties begin to apply in 2012 as follows:
Decrease in amount of total allowed charges for covered professional services
(Part B charges)


2012 1.0%
2013 1.5%
2014 (and beyond) 2.0%

 

QUALIFIED E-PRESCRIBING SYSTEMS - DEFINITION

To participate, prescribers must use a "qualified e-prescribing system", whether it be a standalone software system or integrated into an electronic medical record (EMR). A qualified system must be able to do all of the following using the standards currently in effect for the Part D program, if applicable:

  1. Generate a complete active medication list (with information from PBMs or pharmacies if available).
  2. Select medications, print prescriptions, transmit prescriptions electronically using the applicable standards, and warn the prescriber of possible undesirable or unsafe situations.
  3. Provide information on lower-cost, therapeutically-appropriate alternatives
  4. Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient's drug plan.

An e-prescribing system's certification to connect to Surescripts®, the Nation's E-Prescription Network™ satisfies many (but not all) of these requirements.
Visit  www.surescripts.com/certified to view a list of e-prescribing software systems that have been certified along with the functionality for which they have been certified.

Prescribers should always check with potential e-prescribing software vendors to confirm that their software is qualified under MIPPA guidelines and to request activation of services that deliver the required functionality.

 

WHAT ARE THE REPORTING REQUIREMENTS?

  • An eligible prescriber is considered a "successful e-prescriber" based on a count of the number of times said professional reports that at least one prescription created during a patient encounter was generated using a qualified e-prescribing system. The minimum threshold for this reporting is 25 electronic prescribing events during the 2010 calendar year.
  • The prescriber must identify whether the encounter is an applicable case using the following denominator codes.
    90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014, 96150, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109
  • Note - At least 10% of the prescriber's total Medicare allowed charges must be for services in the measure denominator.
  • The numerator includes the applicable G Code:
    G8553 - at least one prescription created during the encounter was generated and transmitted electronically using a qualified electronic prescribing system

 

ADDITIONAL INFORMATION:

  • The Secretary of HHS has the authority to change the requirements for successful e- prescribing in the future.
  • The MIPPA legislation allows for future use of Part D data in lieu of claims-based reporting by eligible professionals.
  • The MIPAA E-Prescribing incentives are not available if the eligible medical professional earns an incentive payment under the HITECH provisions for those qualifying as "meaningful EHR users."



For more information about the MIPPA E-Prescribing Incentive Program, please visit CMS' online resource page.