E-Prescribing 2009

Oncology ERx

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AGENDA What The Regulations Say How this Applies In Oncology Why ERx is Your Solution FAQs

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The Act Section 132 of the Medicare Improvements for Patients and Providers Act

of 2008 (MIPPA) authorizes a new and separate incentive program for eligible professionals who are successful electronic prescribers (e-Prescribers) as defined by MIPPA. This new incentive program removes the e-prescribing measure from PQRI for 2009, and is in addition to the quality reporting incentive program authorized by Division B of the Tax Relief and Health Care Act of 2006 - Medicare Improvements and Extension Act of 2006 (MIEA-TRHCA) and known as the Physician Quality Reporting Initiative (PQRI).

The e-prescribing incentive is similar to some aspects of the PQRI

incentive in that reporting periods are one year in length and the incentive is based on the covered professional services furnished by the eligible professional during the reporting year. However, this new and separate incentive program is exclusive for adopting and using e-prescribing successfully.

CMS will describe the criteria that will be used to determine what eligible professionals the e-Prescribing Incentive will apply to and how "successful e-Prescriber" will be defined for 2009, in the final 2009 Physician Fee Schedule rule that will be posted in the Federal Register no later than November 15, 2008.

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What Medicare Calls E-Prescribing (2008 PQRI) As a qualified system, the program must be able to perform the following tasks: Generate a medication list Selecting medications, transmitting prescriptions electronically and conducting safety checks*

Providing information on lower cost alternatives

Providing information on formulary or tiered formulary medications, patient eligibility and authorization requirements received electronically from the patient’s drug plan• *Safety checks include: automated prompts that offer information on the drug being prescribed, potential inappropriate dose or route of administration of the drug, drug-drug interactions, allergy concerns, and warnings/cautions.

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Successful Reporting of the eRx Measure for 2009 The measure is intended to be reported on for EVERY patient visit in the denominator.

Successful reporting is defined as reporting the measure on at least 50% of eligible patients or a % of Part D claims to be named later. Limitation: CPT codes that make up the denominator MUST account for at least 10% of the provider’s total allowed charges for Medicare Part B covered services or a number of Part D claims to be named later.

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Incentives for Successful electronic prescribing under MIPPA

A 2% payment incentive for successful use of e-prescribing is available for 2009 & 2010.

In 2011 and 2012 the payment incentive drops to 1% of covered Medicare Part B charges.

In 2013 the incentive drops to 0.5% of the covered Medicare Part B charges

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Future Penalties for Not Electronically Prescribing Fee reduction is prospective, providers will have

to electronically prescribe by a date to be determined to be sure their fees are not reduced in 2012. This date will not be before 2010.

Eligible professionals who are not successfully using electronic prescribing by 2012 will be penalized 1% of their covered Medicare Part B charges. This means that these providers will be paid at 99% for their covered Medicare Part B fee schedule services.

Limitation applies as for incentives Hardship exemption on a case-by-case basis to be

reviewed annually.

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Future Penalties for Not Electronically Prescribing In 2013 - 1.5% deducted from their covered Medicare Part B services. Professionals will be paid at 98.5% of the physician fee schedule for covered services.

In 2014 and beyond penalty will increase to 2%. Professionals will receive 98% of the physician fee schedule for the covered services they provide.

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Part D Information The Secretary 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.

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Implementation Schedule for 2009 PQRI and e-Prescriber Incentive

2009 PQRI including applicable MIPPA provisions Include in 2009 Physician Fee Schedule Rule – comment period ended 8/29/08

2009 Electronic Prescribing Incentive Those relevant to 2009 will be included in PFS Final Rule or otherwise implemented

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Additional Information HHS hosted an electronic prescribing summit in Boston on October 6 & 7. To get a copy of the presentation you can go to this link: • http://www.e-prescribeconference.com

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Coding for E-Prescribing 2009

You must use a QUALIFIED E-prescribing system AND

Have an encounter with one of these codes 90801, 90802, 90803, 90804, 90805, 90806, 90807,

90808, 90809, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, G101, G0108, G0109

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Coding for E-prescribing

Report on all eligible patients: G8443--All prescriptions created during the encounter were generated using an e-prescribing system.

G8445--No prescriptions were generated during the encounter. Provider does have access to a qualified e-prescribing system.

G8446--Provider does have access to a qualified e-prescribing system. Some or all prescriptions generated were printed or phoned in as required by state regulation, patient request, or pharmacy being able to receive electronic transmission.

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Why is Oncology ERx The System for My Practice? It is the only FREE system specifically for Oncology practices.

It was developed by an Oncology Practice for Oncology Practices.

There will be Oncology specific content on the site---automatic updates on e-prescribing just for you!

They are committed to developing relationships for seamless processing.

The system is free and means more money for you--duh!

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FAQs Q: Is e-prescribing just one more government program to make my life miserable?

A: No, e-prescribing, particularly at no cost to you, has very real benefits such as: Less adverse events due to on-line flagging of drug interactions

Real time benefit investigation and eligibility Provision of lower cost alternatives for your patients Proof of prescription adherence Lowering of costs for refill phone calls and prescription renewals.

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FAQs Q: Why do I need e-prescribing? I fax prescriptions right now. Isn’t this e-prescribing?

A: No, to get the 2%, you must use a qualified e-prescribing system. Oncology ERx is a qualified system.

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FAQs Q: Does the e-prescribing initiative include chemo drugs given in our offices?

A: No, it does not unless the drug is picked up at the pharmacy…

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FAQs Q: Is this system really free? How much would it cost if I bought one?

A: Industry estimates for the hardware and software costs of a basic e-prescribing system range from $1,500 to $4,500 per physician. Estimated costs for advanced systems, having complex alerts and reminders, are higher—$29,000 per physician in the first year and $4,000 annually thereafter. MMA authorized grants for e-prescribing in 2007 to help defray some of these costs. You are benefiting from that.

SOURCE: Health Affairs, 24, no. 5 (2005): 1159-116 doi: 10.1377/hlthaff.24.5.1159

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FAQs Q: How much will I make if I do e-prescribing in 2009?

A: Every practice is different…but let’s take an example. The 2%, like PQRI, is based on Part B SERVICES---not drugs and lab. So, Dr. X ‘s allowed Medicare Part B PFS payment in 2007 was $300,000 for E/M and $300,000 drug administration and other stuff. 2% of $600,000 would be $12,000 for Dr. X. But, remember to calculate by NPI to get bonus by physician.

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FAQs Q: Is the patient portion taken out of the calculation of the 2%?

A: No, like PQRI, it is the sum of all Medicare service-related allowables for 2009.

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FAQS Q: How do all of my patients get loaded into this system? Or, do I have to key them in one-by-one?

A: There are three ways for you to get patients into the system: Key punch them in (free). Upload them from a comma delimited file (free).

Create an interface (a cost depending upon where the interface occurs).

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FAQs Q: Does the system check for drug interactions and adverse effects?

A: Yes, it does do that.

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FAQs Q: Does it tell you when the patient fills the prescription?

A: Yes, it does…this is invaluable when a patient is taking an expensive cancer therapy.

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FAQs Q: Will the system tell you eligibility and formulary requirements?

A: Yes, it will do that for all payers on the system. About 90% of payers are on the system.

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Your Questions???

To register right now, go to https://www.oncologyerx.comhttps://www.oncologyerx.com

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Contacts To schedule a demo webinar, call 866-868-0370, ext 001 or 002 Or, e-mail me at bobbibuell1@yahoo.com