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November 2008
Vol. 18 No. 11
Top Stories
ID Physicians Can Increase Medicare Payments in 2009

With a little extra initiative, physicians  may be able to receive more than a 5 percent Medicare pay boost for 2009, according to the 2009 Medicare Physician Fee Schedule.

For 2009, the fee schedule includes an incentive payment of 2 percent of total allowed charges for eligible professionals, including physicians, who successfully file electronic prescriptions for their Medicare patients. Physicians can earn another 2 percent incentive payment to report measures under the Physician Quality Reporting Initiative (PQRI). Both incentive payments are in addition to the fee schedule update Congress approved earlier this year that adds up to 4 percent for ID physicians. The new rates go into effect Jan. 1, 2009.

The Centers for Medicare and Medicaid Services (CMS) is encouraging physicians to e-prescribe in order to eliminate medication errors that result from the misreading of handwritten prescriptions. E-prescribing can also reduce out-of-pocket costs for beneficiaries because it facilitates communication between prescribers and pharmacies on lower-cost generic alternatives.

In order to qualify for the e-prescribing incentive bonus, physicians must have a system that:

  • generates a complete medication list through communication with patients’ pharmacies and benefit managers
  • provides decision-support tools for choosing appropriate medications
  • provides information on lower-cost, therapeutically-appropriate alternative medications and on adverse reactions by interfacing with formularies and/or tiered formularies.
  • provides information about patient eligibility and authorization requirements directly from patients’ Part D drug plans

Physicians can earn the incentive payment even if no medications were prescribed or if e-prescriptions for the drug are prohibited by law, such as in the case of controlled substances, as long as the proper code is included. 

In order to qualify for the e-prescribing incentive payment, professionals must generate at least 10 percent of their Part B charges in the outpatient setting and they must successfully e-prescribe at least 50 percent of the time during these situations.  

The new fee schedule also adopts changes to the PQRI program, including the addition of 52 new quality measures, for a total of 153, in areas including hepatitis vaccinations, HIV/AIDS, and wound care.

IDSA is analyzing these various payment incentives and will update information on our website that explains how ID physicians can participate in the PQRI and successfully e-prescirbe. Check http://www.idsociety.org/qualityimprovement.htm periodically for new information. Information on the PQRI program and the e-prescribing incentive is also available on the CMS website at http://www.cms.hhs.gov/pqri.



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