Tuesday, May 19, 2009. Orthopaedic Specific Open Door Forum. Agenda . Overview of PQRI Overview of E-Prescribing Incentive Program Peer Experience with PQRI and E-Prescribing Question and Answers Session. Open Door Forum Leaders. Sylvia W. Publ, MBA, RHIA (CMS)
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Streamlined prescription renewal process
Increased practice efficiency
Eliminate transcription or legibility errors
Up-to-date medication list
Convenience to the patientBenefits to Participating
How much can a practice earn?
$300,000.00 (Net Medicare revenue earned)
X 2.0% (2009 E-Rx Reporting)
$6,000.00 (Potential Payment for
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)How Can You Participate?
Charges from Codes in the eRx measure denominator X 100 = (%) of Total Medicare Charges
Total Medical Part B Allowed Charges
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%
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.
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
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
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
Clinical Quality Improvement Coordinator, AAOS
Medical Director, AAOS
Executive Director, Midwest Orthopaedics, PA