Final Rule Options, E-Rx Mandates, Newly Introduced Federal Legislation among Practice Management Challenges

The "meaningful use" requirements outlined in the Department of Health and Human Services (HHS) final rule released mid-July will provide practice managers with an abundance of content to digest before the New Year rolls around.

Even though significant improvements have been made from the original rule, there will be challenges to meet the requirements, said Harold Ingram, president-elect of the Medical Group Management Association of Mississippi (MGMA of MS), and CEO of Flowood-based PerforMax, Inc.

"There are two options a clinic may pursue," Ingram said about the most often confusing parts of the final rule. "One is to meet the Medicare requirements. The other is to meet Medicaid requirements. If a clinic is able to meet the Medicare requirements, an Eligible Professional (EP) can receive about $44,000. However, if the EP qualifies under Medicaid guidelines, the EP can receive over $60,000. What may not be realized is that the definition of who qualifies as an Eligible Professional under the two guidelines is different. A nurse practitioner can be considered an EP under the Medicaid definition but not under the Medicare definition. I'm not sure clinics are aware of this difference."

The most important thing for a physician to understand, Ingram emphasized, is that simply having an electronic medical record (EMR) system that is certified as having the capability of meeting the "meaningful use" criteria does not insure the incentive payment will be received.

"The EMR system must be utilized in the treatment process," he said. "To meet some of the core requirements, the EMR system must have certain data recorded on 80 percent of the Eligible Professional's patients."

E-Rx Carrot-and-Stick

The carrot that the Centers for Medicare and Medicaid Services (CMS) is dangling to EPs is a 2 percent bonus on the total allowable charges for service performed during the reporting period, with the stick being in the form of penalties, said Ingram.

"EPs who don't meet electronic prescribing requirements in 2012 will see a 1 percent penalty," he said. "This will continue to increase up to a maximum of 5 percent."

Fortunately, Ingram said, requirements for meeting CMS E-Rx guidelines for 2010 are less stringent than 2009.

"To qualify, an EP is required to e-prescribe in only 25 unique patient visits during the year," he said. "Reporting may be done on a claims-based approach where a G-code is submitted when the 'encounter' is filed with Medicare. Or, it may be reported via registry-based reporting, where a summary of e-prescribing activity is submitted through a qualified organization (registry) at the end of the year."

Ingram pointed to the importance of the technical language by adding that, "For E-Rx, the 10 percent Medicare requirement is actually stated as 10 percent of charges must be for Medicare patients and is based on a specific set of CPT codes. The codes generally relate to patient encounters ... (a term) more easily understood although it's not exactly what's stated."

The EP must use a qualified system for e-prescribing, which calls for generating a complete active medication list interacting with available pharmacies; selecting medications, printing prescriptions, and electronically transmitting prescriptions; providing information related to lower cost and therapeutically appropriate alternatives when available; and providing information on formulary medications, patient eligibility, and authorization requirements received electronically from the patient's drug plan.

"To participate, at least 10 percent of the EP's patient encounters must be with Medicare patients," said Ingram, pointing to ways practices may meet the E-Rx requirements. "Options can include use of an existing practice management system, stand-alone E-Rx system, web portal and EMR system. If the clinic is pursuing implementation of an EMR system to receive stimulus money, Medicare will not pay for both. E-Rx is a requirement to meet the 'meaningful use' guidelines under the stimulus incentive for adoption of electronic health records."

Legislative Watch

A day after the final rule was recorded, four U.S. senators introduced The Health Care Bureaucrats Elimination Act (S3653) to repeal the Independent Payment Advisory Board (IPAB). The sweeping healthcare reform bill Congress passed in April created the IPAB, a 15-member board appointed by President Obama to make binding Medicare policy decisions that decrease the growth in healthcare spending.

"Most physician groups believe this board, which puts significant policy decisions in the hands of a few unelected bureaucrats, will cut reimbursement rates significantly to slow Medicare expenditures," said Ingram. "MGMA national lobbied against the formation of this body."

At press time, Ingram said MGMA of MS members are encouraging practice managers to urge Mississippi Sen. Thad Cochran to support the bill. Mississippi Sen. Roger Wicker is already on board.

"We need to be active and aggressive in this political process," said Tony Palazzo, legislative liaison for MGMA.

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