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Psychiatric Practice & Managed Care
Published Online: 15 October 2010

Still Time to Get 2% Increase for 2010 Medicare Claims

Publication: Psychiatric News
Volume 45, Number 20
https://doi.org/10.1176/pn.45.20.psychnews_45_20_018
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To encourage electronic prescribing (eRx), the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized an incentive program for Medicare providers who use a qualified eRx system when filing claims for 55 specified CPT codes. This program is separate from the ongoing Physician Quality Reporting Initiative, and you don't have to register to participate in it.
Unlike other CMS incentive programs, this one is especially appropriate for psychiatrists. Of the 55 CPT codes that are eligible for the incentive, nine are psychiatry codes, three are health and behavior assessment/intervention codes, and 36 are evaluation and management (E/M) codes. The only other specialty codes included are for ophthalmology.
To qualify for this incentive program, you must use codes in the denominator of the measure (see table) for at least 10 percent of your total Part B Medicare claims—this should be no problem for psychiatrists. And you need to report only the eRx measure for a minimum of 25 encounters before December 31 to receive the full 2 percent incentive, which is based on the value of your total Medicare Part B claims for the calendar year.

How It Works

The electronic prescribing system used can be either a stand-alone system that is used only for prescribing or can be part of an electronic health record system.
A qualified eRx system must be capable of doing all of the following:
•. 
Generating a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers, if available.
•. 
Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all alerts (as defined in the next item).
•. 
Providing information related to lower cost and therapeutically appropriate alternatives, if any. (The availability of an eRx system to receive tiered formulary information would meet this requirement.)
•. 
Providing information on formulary or tiered medications, patient eligibility, and authorization requirements received from the patient's drug plan, if available.
If you are using an e-prescribing system that meets these criteria and can electronically prescribe a medication for patients when using any of the eligible CPT codes, just include the code G8553 when you file your claims.
More information on the eRx incentive program is posted at <www.cms.gov/ERXIncentive/>.

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Psychiatric News
Volume 45 • Number 20 • October 15, 2010
Pages: 8

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Published online: 15 October 2010
Published in print: October 15, 2010

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