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What is the e-prescribing incentive offered by CMS?

In late 2008, CMS announced they were creating an incentive program for physicians using e-prescribing for their Medicare patients. Physicians and other eligible professionals who adopt and use qualified e-prescribing systems to transmit prescriptions to pharmacies may earn an incentive payment of 2.0 percent of their total Medicare allowed charges during 2009. This incentive is in addition to a 2.0 percent incentive payment for 2009 for physicians who successfully report measures under the Physician Quality Reporting Initiative (PQRI), and both incentive payments are in addition to the 1.1 percent fee schedule update required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) go to exit disclaimer (PDF - 56 KB). So, a physician who successfully reports under both the e-prescribing and PQRI initiatives could receive up to a 5.1 percent pay boost for 2009. 

For an e-prescribing system to be eligible for the program it can be either a standalone system or one that is part of an EMR, but it must be able to do the following things:

  • Generate a complete medication list that incorporates data from pharmacies and benefit managers (if available)
  • Select medications, transmit prescriptions electronically using the applicable standards, and warn the prescriber of possible undesirable or unsafe situations. (The prescription must be sent electronically. If the network converts the electronic prescription into a fax because the pharmacy cannot get electronic faxes, this counts as e-prescribing. If the e-prescribing system is only capable of sending a fax directly from the e-prescribing system to the pharmacy, the system is not a qualified e-prescribing system.)
  • Provide information on lower-cost, therapeutically-appropriate alternatives (for 2009, tiered formulary information, if available, meets this requirement)
  • Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient's drug plan

The following resources provide additional information on the CMS e-prescribing initiative:

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