January/February - West Virginia State Medical Association

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Physician Practice Advocate | NEWS CMS Changes for 2009 Medicare has announced a number of changes for 2009. The Centers for Medicare and Medicaid Services (CMS) is encouraging physicians to adopt electronic prescribing for their practices as soon as possible. According to CMS, one of the major advantages of adopting e‐prescribing is the elimination of medication errors which may result from misreading handwritten prescriptions. CMS states that Medicare beneficiaries’ out-of-pocket costs should be less as e‐prescribing will improve communication between physicians and pharmacies regarding lower‐cost generic alternatives. In the 2009 Physician Fee Schedule Final Rule, CMS has created incentives for physicians in order to persuade them to become early adopters of e‐prescribing. Beginning January 1, 2009, eligible professionals may participate in the E‐prescribing Incentive Program by submitting information required by the E‐prescribing measure on their Medicare Part B claims. CMS is providing a 2% payment incentive for successful use of e‐prescribing for the years 2009 and 2010. In 2011 and 2012, the payment incentive decreases to 1% of covered Medicare Part B charges. In addition, the rule states that in 2012, eligible physicians who are not successfully using electronic prescribing will be penalized 1% of their covered Medicare Part B charges. This means that physicians would be paid at 99% of Medicare reimbursement. Penalties would increase as physicians would receive 98.5% of their allowed charges in 2013, and only 98% in 2014. CMS Secretary Leavitt has the ability and authority to change the requirements for successful e‐prescribing in the future. Also, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) allows for the use of Part D data instead of claims based reporting for eligible physicians. In the Final Rule, CMS stated what physicians were required to do in order to earn their e‐prescribing incentive payments. Physicians will need to have a qualified e‐prescribing system which must be able to communicate with the patient’s pharmacy and help the physician identify appropriate drugs, as well as to provide information on generic substitutes for brand-name drugs. The system must be able to provide information on formulary and tiered formulary medications. It must also be able to forewarn physicians about possible adverse events, such as improper dosing, drug-to-drug interactions, or allergy concerns. CMS has also adopted PQRI improvements in the Final Rule. Physicians and other professionals who participate in the PQRI initiative will now be eligible to receive a 2% bonus of allowable charges which are submitted no later than two months after the end of the reporting period for 2009 quality measures. In addition to removing quality measure 125 that was used to report on the use of e‐prescribing, CMS added nine new measure groups, including CABG surgery, rheumatoid arthritis, back pain, coronary artery disease, and HIV/ AIDS. This brings the total number of reportable measures to 153 for 2009. In order to earn the incentive payment, physicians will need to report on every patient visit, using one of three “G” codes for the e‐prescribing measure. When submitting claims for specified types of medical visits to earn the incentive payment, physicians may indicate that they didn’t prescribe any medications during the visit (G8445) or that they used e‐prescribing for any medications prescribed during the visit (G8443). They may also report (G 8446) that some or all the prescriptions generated during the visit were printed or phoned in as required by state or federal law or regulations (i.e. for controlled substances); patient request; or the pharmacy system being unable to receive electronic transactions. Both of the 2% e‐prescribing and the 2% PQRI incentive payments are in addition to the 1.1 percent fee schedule update physicians will receive for services provided under the 2009 Physician Fee Schedule Final Rule. That means that a physician could earn up to 5.1 percent more in 2009 for successful reporting under both the e‐prescribing and PQRI initiatives. It is important to note that a physician or other eligible professional does not have to enroll in order to participate in the E‐prescribing Incentive Program. Furthermore, participation in PQRI is not required in order to participate in this incentive program. January is here, bringing with it many changes, particularly in the world of insurance. As a reminder, some of your patients may also have changed insurance carriers, effective January 1, 2009. In order to ensure that you do not delay your practice’s reimbursement by billing the wrong carrier, it is critical that you require your patients to show their insurance cards when they come for the first appointment in 2009. That will ensure that your practice has the current information on file for each patient. 38 West Virginia Medical Journal
| Call for Papers C a l l f o r P a p e r s Theme: Breast Cancer TOPICS: Detection • Historical Perspectives • Incidence Statistics • Biology • Screening • Prevention • Treatment • Statewide Programs and Partnerships DEADLINE: May 1, 2009 Please send your manuscripts, double-spaced to Angie Lanham, Managing Editor, WV Medical Journal, PO Box 4106, Charleston, WV 25364 or email to: angie@wvsma.com. Please keep in mind that all figures, photos, tables, etc. need to be separate .jpg, .tif or .pdf files or presented camera-ready for scanning and placement. All scientific articles should be prepared in accordance with the “Uniform Requirements for Submission of Manuscripts to Biomedical Journals.” Please go to www.icmje.org for complete details. For additional requirements, please refer to page 48, Manuscript Guidelines. Refer your business operations to a specialist. Just as physicians have specific areas of expertise, developed through education and experience, Physician’s Business Office specializes in the business operations of a medical practice. We can be an extension of your office staff, with the training, experience and cutting-edge tools to make smooth sailing of your practice. Call today to see how our specialists can work with you. 3211 Dudley Avenue, Parkersburg, WV 26104 Call Nicole Needs (304) 834-4977 or Jeff Matheny (304) 422-0578 web: physiciansbusinessoffice.com • e-mail: info@pbo.bz January/February, 2009, Vol. 105 39
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January/February - West Virginia State Medical Association

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