Synchronizing ePrescribing, PQRS, and EHR Criteria
There can be many issues with a conventional paper prescription issued by a doctor. To begin with, most chemists find it difficult to understand illegible handwriting on the prescription, leading to disbursement of wrong drugs or dosages. Secondly, patients may need to return to the doctor for changes in the prescription, such as, extending it, or authorizing substitute medication due to non-availability of prescribed drugs. Thirdly, the chemist may not have the medication prescribed and the patient may have to run from chemist to chemist to get the medication and the list goes on.
A lot of prescriptions are misused and dangerous drugs are procured over the counter. One way is for the patient to get the prescription filled and then go to another chemist and fill it again, if the chemist fails to mark the prescription as filled. Thousands of patients die from wrong medication every month and to prevent such deaths, the US Department of Health & Human Services set up the CMS (Centers for Medicaid & Medicare Services) to oversee what is called the Physician Quality Reporting System (PQRS).
In order to effectively solve the above mentioned problem and ensure all physicians and medical professionals adhere to quality practice norms, the CMS set up the PQRS that requires all medical professionals to register by law and offered incentives to medical professionals to sign up for the eRx system to combat the above mentioned problems.
The electronic network of computer systems called ‘eRx,’ or electronic prescription (ePrescription for short) has effectively resolved all the problems faced by doctors, patients and chemists alike. Patients covered by Medicare can benefit from this facility.
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It is never too late to get started with the CMS PQRS. First of all, any medical professional wishing to get into the eRx, or ePrescription incentive program needs to check with the list of eligible professionals. These include, but are not restricted to:
- Doctor of Medicine
- Doctor of Osteopathy
- Doctor of Podiatric Medicine
- Doctor of Optometry
- Doctor of Oral Surgery
- Doctor of Dental Medicine
- Doctor of Chiropractic
- Physician Assistant
- Nurse Practitioner
- Clinical Nurse Specialist
- Clinical Social Worker
In fact, all professional services covered under the Medicare Physician Fee Schedule (PFS) and physicians charging fee based on the PFS qualify for the PQRS. However, eligible professionals do not have to participate in the PQRS to take part in the eRx or ePrescription incentive program of the Electronic Health Record system.
While there is no sign-up or pre-registration for the eRx incentive program, there are some EHR criteria to be eligible. This includes the professional using any of the qualified eRx systems and reporting to the CMS on his or her adoption of the system. Then the professional must satisfy certain qualifying criteria by using the eRx system for a specified reporting period.
To sum things up:
The incentive is a financial compensation for the medical practitioner that amounts to 2% of a group practice’s total allowed charges for professional services that are covered under the Medicare Part B Physician Fee Schedule, as laid down by the CMS.
Health care providers should ensure that at least 10% of its Medicare Part B charges will be reporting to a particular set of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes.
This reporting is required for at least 50% of the Medicare Part B patients that the professional prescribed medication for in the reporting year.
A professional may submit this information one of three ways: to CMS on its Medicare Part B claims, to a qualified registry, or to CMS via a qualified electronic health record (EHR) system.
While the eRx incentive program was started in 2009 and implemented annually by the CMS that updated the Federal Registry regularly, this financial incentive is set to reduce to 1% by 2012 and further to 0.5% in 2013. In addition to this, all eligible healthcare professionals will face penalties in the form of reduced payments if they fail to meet eprescribing criteria. Should they fail to start eprescribing by 2012, their financial incentive will be reduced by 1%. Failing to do so by 2013 and beyond, the penalty will result in a reduction by 2% of the payment they would normally be entitled to.
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