The Path to Paperless

Earning EMR Bonus Payments

How to take advantage of e-Prescribing and PQRI incentives.

By Peter J. Polack, MD, FACS

As the day approaches when potential financial incentives for the widespread use of electronic medical records kick in, practices are craving accurate information.

What does one need to do to qualify for and then claim these incentives and/or bonuses? Following are explanations of key incentives:

• Meaningful Use Incentives. Financial incentives will be awarded to healthcare providers who can demonstrate what is known as the “meaningful use” of EMR. This is based on a set of goals and objectives in a matrix now being developed by the US Department of Health and Human Services. Some of these goals are more specifically defined than others, but the first will not go into effect until 2011.

Practices will have to demonstrate a certain level of EMR adoption and proficiency to qualify for the federal incentives, which will range from about $2,000 to $18,000 per provider within a given year and up to a maximum of $44,000 per provider over about five years. Those practices that do not adopt EMR within that time period will face financial penalties in the form of cuts in reimbursement.

• e-Prescribing. Also known as e-Rx, is the electronic generation, transmission and filling of a medicinal prescription using either an EMR, practice management system or Web interface system. This is accomplished via the Surescripts/RxHub electronic prescribing network, connecting the prescriber to a majority of retail pharmacies. Working within an EMR system, the process automatically checks for drug allergies, drug-drug interactions and formulary issues.

In 2008, this was part of the Physicians Quality Reporting Initiative (PQRI) program. In 2009, it was spun off from PQRI, with a separate bonus for e-Rx reporting. In 2010, there will be a bonus worth 2% of a practice's allowable professional Medicare charges if each provider uses e-Rx at least 25 times. In 2011, however, e-Rx will be part of the meaningful use standards and providers will need to e-Prescribe for at least 80% of their patients to qualify for the bonus. Beginning in 2012, there will be increasing financial penalties for non-participating providers.

• PQRI Incentives. The PQRI gave physicians their first taste of what was informally known as “pay for performance,” or P4P Specific objectives were listed for certain diagnosis codes, and providers could initially earn a 1.5% bonus. This year it increases to 2%, after which it may gradually decrease and then, as with e-Rx, be folded into the : forthcoming “meaningful use” criteria.

The good news for practices is that this year they can earn a 4% bonus of allowable Medicare charges for professional services — and that is no small incentive for any practice, regardless of size. Still, many practices have complained about technical glitches with the program and trouble getting information about whether or not they qualify for a bonus payment.

We use a program developed by Protodrone, LLC called PQRI Toolset (www.pqritoolset.com) that audits practice billing before it is sent to verify qualification for both PQRI and e-Rx incentives. For 2008, we hit a reporting threshold of 99.7% for PQRI, the highest in the country, which earned our practice a substantial bonus. For more information on the PQRI Toolset, contact Protodrone at 888-569-5593. OM

Note: Ocala Eye PA has a financial interest in Protodrone LLC.

Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multisubspecialty ophthalmology practice located in Ocala, Fla. He is also founder of Emedikon, an online practice management resource for physicians and administrators.