How to get a 5.1 percent "raise" from Medicare

The Centers for Medicare & Medicaid Services released its 2009 physician fee schedule last week, and there's actually some good news: You could get a 5.1 percent pay boost from Medicare next year. But here's the bad news: You'll have to jump through a few more hoops in order to get it.

The potential 5.1 percent increase has three components:

First, there's a 1.1 percent update to the physician fee schedule, which all physicians will receive. This update was required by the Medicare Improvements for Patients and Providers Act of 2008, which averted a 10.6 percent decrease in physician payments.

Next, there's an incentive payment of 2 percent of your total Medicare allowed charges during 2009 if you use a qualified electronic prescribing (e-prescribing) system to transmit your prescriptions to pharmacies. You will also need to report one of three G codes with your claims to indicate either that you used e-prescribing for all medications prescribed during the visit (code G8443), you did not prescribe any medications during the visit (code G8445), or you did not use e-prescribing because the law prohibits it for the specific type of drug prescribed (such as a controlled substance), the patient requested it or the e-prescribing system was temporarily down (code G8446). If this sounds like too much trouble, note that if you don't switch to e-prescribing, your allowed Medicare charges will be reduced by 1 percent starting in 2012 and by 2 percent starting in 2014, when the incentive payments go away. But don't let that taint your view of e-prescribing. As family physician Ken Adler recently wrote in an article for FPM, "E-prescribing has come of age and is truly a win for everyone – patients, payers, pharmacies and physicians" because of the patient safety and other benefits it offers.

Finally, there's a 2 percent incentive payment if you successfully report measures under the Physician Quality Reporting Initiative (PQRI), which was launched in 2007. For 2009, there are 52 new quality measures to choose from, bringing the total number of measures to 153, but you only have to report on three measures 80 percent of the time. For an overview of how the PQRI works, see Measuring for Medicare: The Physician Quality Reporting Initiative.

If you have any e-prescribing or PQRI tips that you'd like to share with your colleagues, please post your comments below.

Posted at 05:24PM Nov 06, 2008 by Brandi White  |  Comments[2]