American Medical Association

The Medicare ePrescribing Incentive Program

Medicare is now offering incentive payments to prescribers who use a qualified system. The payments will be:

1 percent of total Medicare Part B payments in 2011 and 2012
0.5 percent in 2013

This program is in addition to the 1 .5 percent bonus that can be earned under Medicare's Physician Quality Reporting System (PQRS).

eRx penalty: Prescribers who don't use ePrescribing for Medicare in 2011 will see their payments reduced incrementally by up to 2 percent annually. To avoid penalties in 2012 and 2013, a prescriber must report the ePrescribing G-code, G8553, at least 25 times for Medicare office visits and other applicable services for CPT codes included in the CMS ePrescribing measure specification. To avoid penalties in 2012, at least 10 e-prescriptions must occur and be reported on Medicare claim forms by June 30, 2011. To avoid penalties in 2013, an additional 15 e-prescriptions must occur and be reported on Medicare claim forms during calendar year 2011. Exemptions may apply to certain prescribers.

The Medicare incentive payments plus the time saved with ePrescribing are two benefits than can have an immediate positive impact on your practice.

Downloadable Resources

Understanding The Basics of the Medicare Electronic Prescribing Incentive Program
2007 Medicare Charges By Specialty
CMS 1500 claim sample

Frequently Asked Questions

General

How can I contact the AMA about ePrescribing?

Click the feedback icon in the lower right corner of the page to send an email to the AMA.

I want to download a page. Do I need certain software?

No. But to view PDFs you will need to download Adobe Reader (for free).

Who can access this site?

Anyone can access the site.

Learn About ePrescribing

Where can I go for more information about ePrescribing?

A number of recommended resources are available for download to members on this site.

I clicked on a link and nothing happened. Why not?

Most likely, your pop-up blocker prevented the link from opening. Go to your browser settings to temporarily disable pop-up blocking.

Calculate Your Savings

How are my Medicare ePrescribing Incentive and time savings calculated?

Your incentive payment is estimated by multiplying your total Medicare Part B charges by the incentive payment rate for each year from 2009 to 2013.

Your time savings is estimated using an average amount of time that physicians and staff spend on prescription renewal requests, as well as an average amount of time that staff spend on related calls such as clarifications and formulary calls.

Who can use this calculator?

"Calculate Practice Impact" is available to anyone accessing the ePrescribing learning center.

Find an ePrescribing System

How are my ePrescribing systems results decided

The “Find A System” resource uses a weighted points system to match your responses to the questionnaire with in-depth profiles of the ePrescribing systems, which were submitted to the AMA by vendors. Criteria for system selection include: system type (EMR, stand-alone or both); vendor participation in state-level incentive programs; existing practice management system interfaces; free onsite training; practice size; system features, number of users and years on market. Please keep in mind that this information has not been evaluated or substantiated by the AMA.

Where does the system information come from?

All of the information shown about a system has been provided by the vendor and hasn’t been evaluated by the AMA.

Who can use this resource?

“Find A System” is available to anyone accessing the ePrescribing learning center.

How are vendor reviews tabulated?

Vendor reviews are tabulated when users complete an online evaluation form. Users are asked to select the number (1 - strongly disagree, 2 - disagree, 3 - somewhat agree and disagree, 4 - agree,5 - strongly agree) that best indicates their level of agreement with each of the following category statements, and provide an overall five-star scale rating:

Setup: The product integrated easily with processes and other technology in my practice.

Usability: The product is intuitive and with training, easy to learn within the first few weeks of use.

Support: The vendor was very responsive when the user needed support.

Function: The product did everything expected based on information provided by the vendor.

Overall (five-star rating): Based on the quality and efficiency gains seen in the practice, the user would highly recommend this product to colleagues.

Each review displays a user’s individual number ranking for each category statement and their overall five-star scale rating. The user’s overall five-star scale rating will then be averaged with other user star ratings to calculate the vendor’s overall star rating. The display of user feedback is at the discretion of the AMA.

Glossary

Authorization level
The level of access or authority assigned to a user of an ePrescribing or EMR system.
Certification Commission for Health Information Technology (CCHIT)
A recognized certification body for electronic health records and their networks, and an independent voluntary private-sector initiative. Their mission is to accelerate the adoption of health information technology by creating an efficient, credible and sustainable certification program.
Clinical decision support
Computer applications that link health knowledge data with patient-specific data and are designed to assist physicians and other health professionals with decision-making tasks.
Electronic signature
An electronic sound, symbol or process attached to or logically associated with a record and executed or adopted by a person with the intent to sign the record.
Favorites list
A feature included in most ePrescribing systems that allows the prescriber to create custom shortcut lists of frequently prescribed medications and frequently used SIGs. For the prescriber, time spent upfront in creating these lists is well spent as they greatly facilitate the prescribing process and impact prescriber satisfaction with ePrescribing.
Medicare Modernization Act of 2003 (MMA)
The law that authorized the Medicare Part D drug program. Even though the act applies to a single federal program, it is likely to drive transaction practices in almost all of healthcare.

Doctors are not required by the act to prescribe electronically. However, the Medicare Modernization Act regulations do require that after 2009, physicians and pharmacies that prescribe electronically for Medicare Part D beneficiaries must utilize the final standards for transactions approved by the Center for Medicare and Medicaid Services (CMS).

According to regulations, health plans (Part D sponsors) are required to establish and maintain after 2009 an electronic prescription drug program that complies with transaction standards adopted by CMS.
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
The law that authorized the creation of the Medicare Electronic Prescribing Incentive Program.

The incentive program provides for an incentive payment to eligible professionals who successfully ePrescribe medications in 2009 and 2010 equal to 2 percent of their total Medicare payments for the year. The incentive amount is reduced to 1 percent in 2011 and 2012 and is finally reduced to 0.5 percent in 2013.

Penalties for physicians who do not adopt ePrescribing systems begin at 1 percent in 2012 and increase to 2 percent by 2014.
National Provider ID (NPI)
A unique identifier used by CMS to identify an individual health care provider to Medicare Part D sponsors, prescribers and dispensers, in electronically transmitted prescriptions or prescription-related materials for Medicare Part D covered drugs and Medicare Part D eligible individuals.

It is important to note that the NPI is used to identify the individual prescriber and dispenser in the electronic prescription process. Eligibility for the CMS ePrescribing Incentive program is determined at the NPI level, not the practice level.
NCPDP SCRIPT Standard
Data transaction standard maintained by NCPDP that supports ePrescribing transactions including new prescriptions, request and response for prescription renewals (refills), and prescription change requests.
Prior Authorization
The industry and NCPDP are working on a standard for automating the prior authorization process for prescription drugs. Once standardized, it is expected that electronic communication of prior authorization data will be implemented between ePrescribing systems and participating PBMs/health plans.
SIG
Coded instructions used by physicians for communicating medication usage to pharmacists. Shortened from the Latin word "signatura" or "signa." A standard Structured and Codified SIG transaction format is being developed by NCPDP.
Stand-alone electronic prescribing system
Software used to send and receive electronic prescriptions. ePrescribing software is offered in two forms: (1) a software package acquired and downloaded to your office computer, or more commonly, (2) through the Internet, whereby users connect with an ePrescribing software application service provider (ASP).

Stand-alone ePrescribing software does not include an EMR component. It does, however, store and manage patient data specific to the prescribing process (e.g., medication history, medication allergies, patient's preferred pharmacy and physician's frequently prescribed therapies).