e-Prescibing Alert

for physicians who participate in medicare

If you did not do e-Prescribing by June 30, 2011, read article ‘MIPPA e-Prescribing Incentive Program: How to Avoid Medicare 2011 eRx Penalty?’

You only have until November 1, 2011 to apply for the Medicare eRx penalty exemption!


The government gives and the government takes.

The MIPPA (Medicare Improvements for Patients and Providers Act of 2008) program was designed to reward Medicare physicians for e prescribing http://www.tn.gov/ehealth/docs/eprescribing.pdf over a 5 year period: 2009 – 2013. Like the Health Information Technology for Economic and Clinical Health Act or HITECH Act EHR incentive program, there are both rewards for compliance and penalties for non-compliance.

Under the HITECH Act, Medicare health care providers who do not adopt electronic health record technology will be hit with a 1% penalty in 2015, a 2% penalty in 2016 and so forth for up to 5 years.

What are the MIPPA e-Prescribing Incentives?

Based on eligible professional allowed charges for Medicare Physician Fee Schedule (PFS) covered professional services, these are the e-prescribing incentive percent amounts:

Year Incentive
2009 2.0%
2010 2.0%
2011 1.0%
2012 1.0%
2013 0.5%

How do I submit
e-Prescribing Incentive Claims?

You must submit prescriptions using standalone e-Prescribing software or certified electronic health record system.
You must e-prescribe using cpt code G8553
G-code G8553 must be reported on a line item with a charge of $0.00
However, the total charge for the claim must NOT be $0.00


What is code G8553 and when do I report it?
G8553 indicates that at least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system.

The eRx G-code G8553, which supplies the numerator, must be reported:
• on the claim(s) with the denominator billing code(s) that represent the eligible encounter
• for the same beneficiary*
• for the same date of service (DOS)
• by the same eligible professional (individual NPI) who performed the covered service as the payment codes which supply the denominator (codes listed below)
• with a charge of zero dollars ($0.00) or if your billing system/clearinghouse require an amount of more than zero with a nominal amount (e.g., $0.01) that will be denied

* Patients must have traditional Medicare Part B coverage. Claims to Medicare Advantage or private payer plans would not count as they do not pass through the Part B claims database.

What are the denominator codes?
Psychiatry -90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862
Ophthalmology -92002, 92004, 92012, 92014
Behavioral Health – 96150, 96151, 96152
Office visits – 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215
Nursing facility care – 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316
Assisted Living/Domiciliary – 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337
Home visits – 99341, 99342, 99343, 99345, 99347, 99348, 99349, 99350
Pelvic/clinical breast exam – G0101
Diabetes Self-management training – G0108, G0109

from CMS e-Rx Incentive & Penalty


Consult CMS.gov e-prescibing   for more details on the Medicare eRx incentive program. But if you use qualified eRx software, it should be painless to get your e-Prescribing incentive money.

Got questions?
about the HITECH Act, Electronic Health Records or the
Centers for Medicare Medicaid Services (CMS)
EHR incentive program

I invite you to claim free access to an informative interview audio titled

How To Convert To Electronic Health Records,
When I’m Completely Technology Adverse,
And Don’t Know Where To Start!


Is electronic health record adoption a mystery to you?

Don’t have the time or expertise?

Want to take advantage of EHR incentive money?


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