1. Are you an office-based provider who prescribes medications to patients?
2. Do any of the services or procedures below make up more than 10% of your Medicare claim volume?
Psychiatric, Therapeutic, Ophthalmological, Health and Behavior Assessment/Intervention,
Evaluation and Management (E/M), Nursing Facility Care, Domiciliary, Rest Home, Custodial Care, Home
Services, Screening, Cervical, or Training Services for Diabetes.
3. Are you submitting more than 200 Medicare claims per year?
4. Are you prescribing on paper or are you e-prescribing but not reporting the G code on your claims?
If you answered yes to all, you must act now to avoid Medicare Payment penalties beginning in 2012 and 2013.
To avoid a 1% Medicare payment penalty effective January 1, 2012, you must submit at least 10 eRx’s during January 1, 2011-June 30, 2011.
To avoid a 1.5% Medicare payment penalty effective January 1, 2013, you must submit an additional 15 eRx’s during the rest of calendar year 2011.
You must report the appropriate eRx G Code with your Medicare Part B claims. If you are electronically prescribing, report G8553 on the claim.
If you do not have prescribing privileges, you must report G8644 or one of the hardship G codes at least one time on an eligible claim prior to June 30, 2011 to avoid the penalties.
Providers who successfully e-prescribe 25 unique visits during the calendar year 2011 will receive a 1% bonus payment for all Medicare claims as well as avoid the above payment penalties.
What if I am already participating in the EHR Incentive Program for Meaningful Use, will I be penalized for not providing the G Code to Medicare for the eRx Incentive Program?
Yes, even though you are participating in the EHR Incentive Program for Meaningful Use, you must also report the appropriate G Code to Medicare for the eRx Incentive Program to avoid the penalties.
If you are signed up for both programs, you will receive the incentive payment for the EHR Program for Meaningful Use. You cannot receive incentive payments for both programs.
For more information on this topic please visit the CMS website at: https://www.cms.gov/ERxIncentive.
What should you do if you are currently e-prescribing in 2011?
You should report G8553 on your claims to Medicare. If you are using StreamlinePM+TM and need assistance with eRx claim reporting; please contact the HELPDESK at 1-866-460-0388.
What should you do if you are not currently e-prescribing in 2011 and you have an EHR?
Contact your EHR vendor to see what needs to take place to get you set up to e-prescribe so you can start reporting to Medicare. If you are using StreamlineEHR; please contact the HELPDESK at 1-866-460-0388.
What should you do if you are not currently e-prescribing in 2011 and you do not have an EHR?
Please contact Sales at StreamlineMD at 1-866-406-2224.
2011 Physician Quality Reporting System and Electronic Prescribing Incentive Program
National Provider Call with Question and Answer Session
May 17, 2011 from 1:30 p.m. - 3:00 p.m. EDT
Registraton is required at: