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CMS-eRX: Faxed Prescriptions Don't Qualify for Medicare Bonuses

MedpageToday

BOSTON, Oct. 8 -- Prescriptions must be sent directly from a medical practice's computer to the pharmacy's computer in order to qualify for the 2% bonus promised by Medicare for e-prescribing.


This warning was written in boldface at the CMS conference on e-prescribing in Boston. CMS organized the meeting to educate physicians on how to reap the financial rewards for e-prescribing authorized by the federal Medicare Improvements for Patients and Providers Act of 2008.


Under MIPPA, doctors who e-prescribe for Medicare patients in 2009 and 2010 will receive a 2% percent bonus based on their total Medicare revenue, with smaller bonuses in succeeding years and penalties kicking in for doctors who don't e-prescribe beginning in 2012.


The key to qualifying for the bonuses -- and avoiding the penalties -- is having an e-prescribing system that meets the definition set out under CMS's Physician Quality Reporting Initiative. Under PQRI, an e-prescribing system must transmit a script electronically to the pharmacy via a technology called electronic data interchange, or EDI. It's the same technology used in online banking.


EDI unleashes the full power of electronic prescribing for improving patient care and cutting costs. Faxing a prescription -- either with a fax machine or straight from a computer -- requires someone at the pharmacy to re-enter the data into its computer system.


"That adds the potential for human error," said Kate Berry, senior vice president of business development at SureScripts-RxHub, a company formed by the pharmacy industry to automate prescribing.


EDI also allows the pharmacy to electronically notify the doctor that a patient has requested a prescription renewal. Such two-way electronic communication means one less disruptive phone call or fax from the pharmacy that the doctor and his staff have to handle, said Berry, who spoke at the CMS conference.


An estimated 60,000 healthcare providers, the vast majority of them physicians, send scripts to pharmacies via EDI, according to Berry. In contrast, she said, roughly 100,000 providers fax prescriptions that were written with electronic health record systems and stand-alone e-prescribing software.


Why the heavy reliance on faxing, a technology born in the 19th century? For one thing, many doctors don't realize that their software programs are capable of EDI, so they haven't turned the feature on.


Sometimes they're using older versions of programs that aren't EDI-ready and haven't upgraded to the latest version.


In a small percentage of cases, prescription-faxing doctors have software that's simply not designed for EDI.


There are at least two sources of information that will help physicians find out whether their software supports EDI.


SureScripts-RxHub published a list of software programs and vendors at that are certified to communicate electronically with members of its pharmacy network, which includes independent stores and chains such as Wal-Mart.


A Web site called GetRxConnected.com -- a joint venture of the Center for Improving Medication Management and several medical societies -- offers an e-prescribing readiness test that tells you whether your software is certified.


Even with the right software, many doctors have resorted to faxing prescriptions because 21 percent of all pharmacies -- largely independents -- can't receive them in EDI fashion, said Berry. The percentage of hold-outs has been steadily declining, however.


The imperative for electronic transmission of prescriptions, in theory at least, will soon affect doctors who prescribe medications under Medicare Part D, which covers 57% of all Medicare beneficiaries.


There's no requirement under Part D that would specifically force physicians to e-prescribe, but on Jan. 1, federal regulations will prohibit faxing of computer-generated prescriptions for patients in this program.


There are no enforcement mechanisms that doctors have to fear if they continue faxing Part D scripts written with computers, CMS officials at the conference said.


The only party to feel any possible repercussions would be a Part D prescription drug plan, which CMS would pressure to get pharmacies and doctors connected through EDI.


However, faxed Part D prescriptions won't help qualify doctors for MIPPA bonuses or avoid penalties that take effect in 2012.