ePrescribing (eRx)

Disadvantages in manual prescriptions:

• Lack of drug-drug and drug-allergy information
• Unclear or illegible writing causes 25% of prescription-related medical errors.
• High turnaround time to refill
• Lack of documentation of past medications
• Adverse drug events
• About 40% of traditional prescriptions need pharmacists and doctor coordination
• Confirmation calls on patient arrival

Advantages of e-Prescription:

• Fast - Your prescription arrives at your pharmacy before you leave your doctor’s office.
• Legible - There is no handwriting for the pharmacist to interpret.
• Economical - makes it easier for your doctor to prescribe the most cost effective medication based on your insurance coverage
• Convenient - You don’t have to make that extra trip to drop off your prescription at the pharmacy.
• Improves quality of care
• Improves patient’s safety
• Provides real-time alerts for drug-drug, drug-allergy, and other interactions based on patient’s EMR
• Supports in overall medication management process
• Supports track of patient’s medication history
• Increases efficiency
• Reduces medication errors
• Saves staff’s time by decreasing requirements of pharmacy coordination
• Eliminates paper work
• Tracks patient flow-sheet with drug and lab history
• Reduces the need for phone calls between prescribers and dispensers

Key Features and benefits of MDCare e-Prescribing:

• Compliant with electronic prescription regulations
• Supports quick and accurate drug refill process
• Manages list of commonly prescribed drugs
• T racks years of patient’s medical history
• Reduces overhead costs
• Transmits prescriptions directly to patient’s preferred pharmacy
• Provides integrated drug database and drug decision support engine
• Indicates Drug-drug and Drug-allergy interactions
• Reconciles current orders with past prescriptions to avoid medication errors such as omissions, duplications, and dosing errors
• Quickens prescription refill processing
• Provides physician preferred drug list for ease of prescribing
• Provides prescription tracker for monitoring transmission status
• MDCare with eRx can reduce medical errors by 95%

Meeting CMS Guidelines

Beginning January 1, 2012 Part D prescriptions can no longer be sent to pharmacies by computer generated fax. If your EMR or e-prescribing system is not enabled to send prescriptions to pharmacies electronically by this date prescriptions must be printed and handed to the patient, or manually faxed.
Click here for CMS presentation on PQRS & eRx Incentive Program

Claims-Based Reporting Principles for Electronic Prescribing (eRx) Incentive Program

For successful reporting under the 2011 eRx Incentive Program, a single quality-data code (eRx G-code G8553) should be reported, according to the coding and reporting principles specified in 2011 eRX Claim based reporting principles

'Duplicative' e-prescribing, EHR incentive schedules to be modified, aligned

The Centers for Medicare and Medicaid Services (CMS), under increasing pressure from providers to modify potential conflicts in its electronic prescribing incentives schedule with its electronic health record (EHR) incentive program, suggested changes in a proposed rule published in the June 1 Federal Register.

Responding to claims that the schedules were "administratively confusing, cumbersome, and unnecessarily duplicative," CMS has proposed expanding the exemptions--and the time to report them--so providers can avoid the payment penalties.

Under the initial e-prescribing requirements released in 2009, providers were required to e-prescribe 10 orders between Jan. 1 and June 30, 2011, to avoid a 1 percent Medicare payment cut in 2012.

One of the exemptions includes letting providers delay purchase of an e-prescribing system because they intend to participate in the EHR incentive program for 2011. Also, providers who prescribe drugs could qualify for an exemption if they don't write many prescriptions, or work in an area that restricts e-prescribing, such as prohibitions on paperless orders for narcotics. The proposed rule also revises the original description of qualified e-prescribing systems

Current Significant Hardship Exemptions for the 2012 eRx Payment Adjustment

If you do not use e-prescription, you would need to report the hardship codes, which explains why you are not using the e-prescription. Failure to report the hardship code, will also lead to penalty from Medicare. The hardship codes are as follows;

G8642: The eligible professional practices in a rural area without sufficient high speed internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act

G8643: The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act

The CMS proposed rule calls for giving providers who fail to meet current requirements a second chance by reporting one of several hardship exemptions through a special website by Oct. 1

Proposed Additional Significant Hardship Exemption Categories for the 2012 eRx Payment Adjustment

Category 1: Eligible Professionals Who Register to Participate in the Medicare or Medicaid EHR Incentive Programs and Adopt Certified EHR Technology

To be considered for this significant hardship exemption under this category, the eligible professional, at a minimum, must:

(1) have registered for either the Medicare or Medicaid EHR Incentive Program (for instructions on how to register for one of the EHR Incentive Programs, refer the Registration and Attestation page of the EHR Incentive Programs CMS-3248-P 19 section of the CMS Web site at http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp#TopOfPAge and
(2) Provide identifying information as to the certified EHR technology (as defined at 45 CFR 170.102) that has been adopted for use no later than October 1, 2011, for a hardship exemption to be submitted to CMS, which then would be reviewed on a case-by-case basis.

Category 2: Inability to Electronically Prescribe Due to Local, State, or Federal Law or Regulation
Eligible professionals in this situation face a significant hardship with regard to the requirements for being successful electronic prescribers because while they may meet the 10-percent threshold for applicability of the payment adjustment, they may not have sufficient opportunities to meet the requirements for being a successful electronic prescriber because Federal, State, or local law or regulation may limit the number of opportunities that an eligible professional or group practice has to electronically prescribe.

Category 3: Limited Prescribing Activity
Eligible professionals who have prescribing privileges but do not prescribe or very infrequently prescribes in their practice It is a significant hardship for eligible professionals who have prescribing privileges, but infrequently prescribe, to become successful electronic prescribers because the nature of their practice may limit the number of opportunities an eligible professional or group practice to prescribe, much less electronically prescribe.

Category 4: Insufficient Opportunities to Report the Electronic Prescribing Measure due to Limitations of the Measure's Denominator

It would be a significant hardship for eligible professionals who do not have a sufficient opportunity to report the eRx measure because of the limitations of the eRx measure's denominator to meet the criteria for being a successful electronic prescriber.

To request a hardship exemption

for any of the categories proposed and previously described an eligible professional or group practice participating in the 2011 eRx GPRO must submit the hardship request by no later than October 1, 2011, which, if submitted by mail, means postmarked no later than October 1, 2011 with the following information:

• Identifying information such as the TIN, NPI, name, mailing address, and e-mail address of all affected eligible professionals.
• The significant hardship exemption category (ies) above that apply.
• A justification statement describing how compliance with the requirement for being a successful electronic prescriber for the 2012 eRx payment adjustment during the reporting period would result in a significant hardship to the eligible professional or group practice.
• An attestation of the accuracy of the information provided.

The justification statement should be specific to the category under which the eligible professional or group practice is submitting its request and must explain how the exemption applies to the professional or group practice.

AMA-ERx Guidelines

AMA Releases New Edition of E-Prescribing Guide
The American Medical Association and four partner organizations in late April issued an updated version of "A Clinician's Guide to Electronic Prescribing." The organizations said the guide reflects changes in the health care environment. The original guide, published in 2008, predated events aimed at pushing physicians toward e-prescribing. The events include the Medicare e-Rx program, which pays physicians bonuses for e-prescribing through 2013. Physicians who don't e-prescribe by 2013 will see a 1% reduction in Medicare payment that increases to 2% in 2014 and each subsequent year.
www.ama-assn.org/resources/doc/hit/clinicians-guide-erx.pdf