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Orthopaedic Specific Open Door Forum Tuesday, May 19, 2009.

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Presentation on theme: "Orthopaedic Specific Open Door Forum Tuesday, May 19, 2009."— Presentation transcript:

1 Orthopaedic Specific Open Door Forum Tuesday, May 19, 2009

2 Agenda Overview of PQRI Overview of E-Prescribing Incentive Program Peer Experience with PQRI and E-Prescribing Question and Answers Session 2

3 Open Door Forum Leaders Sylvia W. Publ, MBA, RHIA (CMS) Robert H. Haralson, III, MD, MBA (AAOS) Toya M. Sledd, MPH, MBA (AAOS) Barbara Sack, MHSA, CMPE (AAOE)

4 E-Prescribing Incentive Program Authorized by MIPPA 2008 Implemented January 1, 2009 Separate from and is in addition to PQRI Physicians can begin reporting for 2% bonus in 2009 & 2010 (We recommend reporting 100%) Report on one of three G-codes 50% of the time on Medicare Part B claims (We recommend reporting 100%)

5 Benefits to Participating Alert for drug to drug, drug to allergy and other patient safety checks Streamlined prescription renewal process Increased practice efficiency Eliminate transcription or legibility errors Up-to-date medication list Convenience to the patient

6 Challenges to Participating Financial Cost and Return on Investment (ROI) Modifying Practice Workflow Prescribing Controlled Substances Hardware and Software Selection Pharmacy, Payer/PBM and Mail Order Connectivity

7 E-Prescribing Incentive Payments Calendar YearIncentive amount % % % 2014 and beyond0% Incentive payments are based on all Part B allowed charges. Incentive payments are based on all Part B allowed charges.

8 Revenue Generating How much can a practice earn? $300, (Net Medicare revenue earned) X 2.0% (2009 E-Rx Reporting) $6, (Potential Payment for reporting) This does not include the additional 2.0% incentive payment if you participate in PQRI.

9 How Can You Participate? No registration required Qualified E-Prescribing System At least 10% of total Medicare Part B payments come from a list of office based codes (denominator codes). Report at least 50% of the time during these eligible patient encounters using one of three G- codes (numerator codes)

10 Qualified E-Prescribing System Generate a complete active medication list Generate a complete active medication list Allow physician to select medications, print prescriptions, transmit prescriptions electronically Allow physician to select medications, print prescriptions, transmit prescriptions electronically Provide information on lower cost, therapeutically appropriate alternatives (if available) Provide information on lower cost, therapeutically appropriate alternatives (if available) Provide information on formulary medications, patient eligibility and authorization requirements (if available) Provide information on formulary medications, patient eligibility and authorization requirements (if available) Must comply with all Part D specifications Must comply with all Part D specifications

11 Office Based Codes (Denominator Codes) Service/ProcedureCPT/HCPCS Code New Patient99201, 99202, 99203, 99204, Established Patient99211, 99212, 99213, 99214, Consultations99241, 99242, 99243, 99244, Screening and Diabetic TrainingG0101, G0108, G0109

12 G-Codes (Numerator Codes) - ALL prescriptions created during the encounter were generated using a qualified e-prescribing system. G ALL prescriptions created during the encounter were generated using a qualified e-prescribing system. - NO prescriptions were generated during the encounter, but the eligible professional has access to a qualified e-prescribing system. G NO prescriptions were generated during the encounter, but the eligible professional has access to a qualified e-prescribing system. - SOME or ALL the prescriptions generated during the encounter were printed or phoned in because of state or federal law or regulation or patient request, because the pharmacy system was unable to receive the electronic transmission, or because the physician prescribed a narcotic or other controlled substance to the patient. G SOME or ALL the prescriptions generated during the encounter were printed or phoned in because of state or federal law or regulation or patient request, because the pharmacy system was unable to receive the electronic transmission, or because the physician prescribed a narcotic or other controlled substance to the patient.

13 Determining Percentage of Total Medicare Charges Eligibility Calculation: Charges from Codes in the eRx measure denominator X 100 = (%) of Total Medicare Charges Total Medical Part B Allowed Charges Example: Charges from Codes in the eRx measure denominator (office based codes) = $186,663 Total Medical Part B Allowed Charges = $797,705 $186,663 X 100 = 23.4% $797,705 The Medicare Part B charges for the codes in the denominator of the measure makes up 23.4% of your total Medicare Part B allowed charges, which means that physician is eligible and can participate.

14 What About Prescribing for Controlled Substances? DEA has authority through the Controlled Substances Act over e-prescribing of controlled substances, and currently does not allow it. DEA has authority through the Controlled Substances Act over e-prescribing of controlled substances, and currently does not allow it. Physicians can still report on the e-prescribing quality measure by using G-code, G8446. Physicians can still report on the e-prescribing quality measure by using G-code, G8446.

15 E-Prescribing Scenario #1 A 66-year old male presents to Dr. Bones's office for medical care Returning Patient (99213) Patient has swelling in the left knee. Dr. Bones discuss current medications and e-prescribes anti- inflammatory medication. Dr. Bones Reports G8443

16 E-Prescribing Scenario #2 A 28-year old male presents to Dr. Bones's office for medical care New Patient Encounter (99203) Patient has a sprain in right wrist, no fractures. Dr. Bones advise Patient to put ice on wrist and take Tylenol (Acetaminophen). No Rx generated. Dr. Bones Reports G8445

17 E-Prescribing Scenario #3 A 51-year old female presents to Dr. Bones's office for medical care Returning Patient with new problem (99214) Patient complains of persistent pain and inflammation in the left hip. Dr. Bones e-prescribes an anti-inflammatory medication and provides a written prescription at the request of the patient for pain medication. Dr. Bones Reports G8446

18 How To Report on Your Claim

19 What Happens If You Dont Participate? Calendar Year Penalty % % 2014 and beyond-2.0% Physicians can expect to see these reductions in their total allowed Medicare Part B charges. Physicians can expect to see these reductions in their total allowed Medicare Part B charges.

20 Available Resources AAOS (www.aaos.org/research/committee/evidence/qualityinitiatives.asp)www.aaos.org/research/committee/evidence/qualityinitiatives.asp CMS Website (http://www.cms.hhs.gov/ERXincentive) and (http://www.cms.hhs.gov/pqri/)http://www.cms.hhs.gov/ERXincentivehttp://www.cms.hhs.gov/pqri/ AMA E-Prescribing Learning Center (http://www.ama-assn.org/ama/pub/erx/home.shtml)http://www.ama-assn.org/ama/pub/erx/home.shtml Get Connected (www.getrxconnected.org)www.getrxconnected.org National ePrescribing Patient Safety Initiative (http://www.nationalerx.com/)http://www.nationalerx.com/ SureScripts (http://www.surescripts.com/certified)http://www.surescripts.com/certified CCHIT (http://www.cchit.org/)http://www.cchit.org/

21 Important Contacts Toya M. Sledd, MPH, MBA Clinical Quality Improvement Coordinator, AAOS Robert H. Haralson, III, MD, MBA Medical Director, AAOS Barbara Sack, MHSA, CMPE Executive Director, Midwest Orthopaedics, PA

22 Thank You! Questions? 22


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