Urology Coding Alert

If you aren't e-prescribing in 2011, you'll face pay cuts next year, CMS says.

You won't face the same nail-biting payment woes in 2011 as you did in 2010, thanks to a Senate Finance Committee bill that will keep Medicare reimbursements for the next 12 months at rates similar to the last half of 2010.

Stop Worrying About a 25 Percent Cut

The House of Representatives passed the Medicare and Medicaid Extenders Act of 2010 on Dec. 9, 2010, following ratification by the Senate the day before. President Obama signed the bill on Dec. 15. This bill eliminated the 25-percent reimbursement cut that medical practices would have faced on Jan. 1, 2011.

Physicians cheered the news that they won't have to wait for the new Congress and Senate members to take their seats before determining whether a payment fix would take place. "The AMA welcomes bipartisan House passage of legislation to stop the Medicare physician payment cut for one year," said AMA president Cecil B. Wilson, MD, in a statement on Dec. 9. "Stopping the steep 25 percent Medicare cut for one year was vital to preserve seniors' access to physician care in 2011. Many physicians made clear that this year's roller coaster ride, caused by five delays of this year's cut, forced them to make difficult practice changes like limiting the number of Medicare patients they could treat."

Learn more: The full text of the legislation can be found on the Senate Finance Committee's Web page at http://finance.senate.gov/legislation

Get Your E-Scribe Plan in Place ASAP

E-prescribing is technically considered "optional," but if you are considered capable of participating and you choose not to do so in 2011, you could face payment penalties starting in 2012. That's the word from a Dec. 13 PQRI National Provider Call sponsored by CMS.

Between 2012 and 2014, the payment adjustment will kick in for practices that are not successful e-prescribers. Eligible professionals who don't e-prescribe in 2011 could collect one percent less than the Medicare Physician Fee Schedule amount in 2012, and that pay cut will go up to 1.5 percent in 2013 and two percent in 2014, said CMS's Daniel Green, MD, during the call.

How it works: CMS will analyze claims data from Jan. 1, 2011 through June 30, 2011 to determine whether you've submitted at least ten e-prescriptions during the first six months of 2011. If not, you could be looking at the potential one percent payment cut in 2012.

"The reporting mechanism to avoid the payment adjustment is only valid through claims," Green said. If you're trying to earn an incentive, CMS will accept that through registries, but only claims submission will determine whether you're subject to the payment adjustment, he noted. For more on CMS's eprescribing program, visit www.cms.gov/ERxIncentive.