Cardiology Magazine — March-April 2011
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Practice Management

Avoid the 2012 e-Prescribing Penalty!
Are you e-prescribing? Do you think you have until January 2012 to start before it affects your Medicare payments? Do you think that if you’re participating in the new electronic health record (EHR) incentive program you won’t have to worry about the e-prescribing incentive program? Think again.

Under the Medicare Improvements for Patients and Providers Act of 2007 (MIPPA), qualified e-prescribers receive bonus payments for successful participation in 2008 through 2011. Beginning in 2012, however, qualified e-prescribers will be penalized if they do not successfully participate. The kicker is that the Centers for Medicare and Medicaid Services (CMS) has announced that it will actually use e-prescribing data from January through June 2011 to determine whose payments will be reduced in 2012. This means health care providers who have not begun to report on the 2011 e-prescribing requirements by the end of June 2011, will see all of their 2012 Medicare payments reduced by one percent.

The new EHR Incentive Program is also a source of confusion. Despite a statutory requirement for CMS to align quality measurement programs, CMS has declined to do so this year. Thus, those participating in the EHR Incentive Program will need to track and report two different e-prescribing measures to avoid facing the penalty for not successfully participating in the e-prescribing program. The ACC, along with the American Medical Association and other physician organizations, continues to protest the CMS decision, but in the interim cardiovascular professionals who participate in the EHR Incentive Program without also participating in the e-prescribing program will face harsh consequences.

Exceptions to the 2012 Penalty

The e-prescribing incentive program is open to physicians who furnish a certain prescribed list of services and where those services comprise at least 10 percent of the physician’s Total Medicare Part B allowed charged for covered professional services. An individual’s participation is tracked by National Provider Identifier (NPI) and bonus payments (and payment adjustments) are made to that same NPI. To be considered during the reporting period, claims for services rendered by June 30, 2011 must be submitted by the end of July 2011. Submissions must be made via claims. Registries and EHRs are not acceptable reporting mechanisms for the e-prescribing program for the purposes of avoiding the 2012 payment adjustment.

However, not all eligible professionals will be subject to the 2012 e-prescribing penalty, according to CMS. Eligible physicians, nurse practitioners and physician assistants who have not filed a minimum of 100 claims involving one of the above encounter codes between January 1, 2011 and June 30, 2011 will not be subject to the penalty. Additionally, eligible professionals whose Medicare Part B allowed charges associated with the applicable encounter codes equate to less than 10 percent of the eligible professional’s total Medicare Part B allowed charges will not be subject to the penalty. CMS has also created an exception for eligible professionals who do not have prescribing privileges from January through the end of June 2011. These individuals must report an additional G-code on at least one claim during that timeframe.

The Agency has also created two hardship exceptions:

• Eligible professional practices in a rural area without sufficient high speed internet access

• Eligible professional practices in an area without sufficient available pharmacies for electronic prescribing.

Two additional G-codes have been made available for reporting in these two situations and must be reported on by affected individuals at least once between January 1 and June 30, 2011.

More information on the e-prescribing program is available at In addition, a special session on “Getting Your Bonus: Navigating EHR and e-Prescribing Incentive Programs” will be held on Monday, April 4 from 1:45 – 2 p.m. in the ACC Central Theater on the Expo floor during ACC.11.

ACC.11 Programming Designed to Help Practices Navigate Health Care Delivery Changes

Managing a cardiology practice has never been more challenging. In an effort to help cardiovascular professionals navigate this swiftly changing environment, ACC.11 will offer an exciting line-up of practice management programming. Of particular note, special Saturday sessions devoted entirely to practice management issues ranging from the need for physician leadership in America’s heart centers to innovative delivery and alternative payment models. On Sunday, spend the day at the ACC/MedAxiom/MGMA Practice Administrator Spotlight, which will address practice and compensation trends, as well as how to make integration work. See below for an overview of the sessions you will not want to miss in New Orleans.

credo Session Aimed at Helping Cardiologists Treat Diverse Patient Populations

As part of its ongoing efforts to give health care providers information and tools to equitably treat their diverse patient populations with or at risk of cardiovascular disease, the ACC’s Coalition to Reduce Disparities in CV Outcomes (credo) will be hosting and/or partnering on several ACC.11 activities in New Orleans.

The two biggest events involve the CardioSmart Health Fair on Saturday, April 2 and a special “Lunch with the Experts” session on Sunday, April 3 at 12:30 p.m. in the Ernest N. Morial Convention Center, Room 254. The session, titled “Making the Case for Culturally-Competent Cardiovascular Disease Care: Case-Based Training for Cardiology: A credo Initiative,” will provide a brief overview of key credo concepts and walk through two cardiovascular disease clinical cases to raise awareness and address optimal therapy and communication with diverse patient populations.

To learn more about credo and read the recent white paper published in the Journal of the American College of Cardiology on “Why credo Matters to Cardiologists,” visit