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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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Presentation Transcript
  • Overview of PQRI
  • Overview of E-Prescribing Incentive Program
  • Peer Experience with PQRI and E-Prescribing
  • Question and Answers Session
open door forum leaders
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)
e prescribing incentive program
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
  • Report on one of three G-codes 50% of the time on Medicare Part B claims (We recommend reporting 100%)


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

Benefits to Participating


challenges to participating
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


e prescribing incentive payments
E-Prescribing Incentive Payments
  • Incentive payments are based on all Part B allowed charges.


revenue generating
Revenue Generating

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


  • This does not include the additional 2.0% incentive payment if you participate in PQRI.


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)

How Can You Participate?


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


g codes numerator codes
G-Codes (Numerator Codes)
  • G8443- ALL prescriptions created during the encounter were generated using a qualified e-prescribing system.
  • G8445 - NO prescriptions were generated during the encounter, but the eligible professional has access to a qualified e-prescribing system.
  • G8446 - 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.


determining percentage of total medicare charges
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


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.


what about prescribing for controlled substances
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.
  • Physicians can still report on the e-prescribing quality measure by using G-code, G8446.


e prescribing scenario 1
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


e prescribing scenario 2
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


e prescribing scenario 3
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


what happens if you don t participate
What Happens If You Don’t Participate?
  • Physicians can expect to see these reductions in their total allowed Medicare Part B charges.


available resources
Available Resources
  • AAOS (www.aaos.org/research/committee/evidence/qualityinitiatives.asp)
  • CMS Website (http://www.cms.hhs.gov/ERXincentive) and (http://www.cms.hhs.gov/pqri/)
  • AMA E-Prescribing Learning Center


  • Get Connected (www.getrxconnected.org)
  • National ePrescribing Patient Safety Initiative (http://www.nationalerx.com/)
  • SureScripts (http://www.surescripts.com/certified)
  • CCHIT (http://www.cchit.org/)


important contacts
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