Medicare ePrescribing Payments

HR 6331, which became law in July, includes additional reimbursement to providers using ePrescribing beginning in 2009.

The new law adds 2% to “the allowed charges under this part for all covered professional services furnished by the eligible professional (or group, as applicable) for the codes to which the electronic prescribing quality measure applies” beginning in 2009.  The additional reimbursement for ePrescribing continues through 2013:

  • 2009 – additional 2.0%
  • 2010 – additional 2.0%
  • 2011 – additional 1.0%
  • 2012 – additional 1.0%
  • 2013 – additional 0.5%

The law also decreases reimbursements to providers not using ePrescribing beginning in 2011:

  • 2012 –  99% of regular reimbursement (1% less)
  • 2013 – 98.5% of regular reimbursement (0.5% less)
  • 2014 and each subsequent years – 98% of regular (2% less)

Because of the reductions, the law maintains a 2% increase/differential for using ePrescribing each year.

How much will a provider need to ePrescribe to obtain the 2%?

Per the new law “…at least 50 percent of the cases in which such measure is reportable…”.  It would therefore appear that in order to qualify, providers will need to implement ePrescribing in 2008 or very early 2009.

Providers will certainly be wondering – should I implement an ePrescribing solution or an EHR inlcuding ePrescribing?

This is a short term vs. long term benefits question.

  • Many experts believe congress will move toward incentives for EHRs (or dis-incentives for not using an EHR).  HHS recently announced a program that will provide up to $58,000 per provider to implement EHRs in 12 communities in the US.
  • A stand-alone ePrescribing system may be less expensive in the short-term but it doesn’t offer the other benefits of an EHR, including increased reimbursement for correct coding levels.
  • The provider and clinic will probably have to start over with ePrescribing when they move to an EHR.

Is 2% worth it?

Each practice needs to answer this question but consider this: according to some surveys the average physician receives over $150,000 per year in payments from Medicare.  Adding 2% means an additional $3,000 per year.  This additional reimbursement may make the decision to implement an affordable EHR, like Sevocity EHR, even easier.

Catherine Huddle – VP, Market Development