MIPPA Update

MIPPA Incentives

• Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)

MIPPA Penalties

• Penalties for not e-Prescribing

Year Penalty

2012 -1%

2013 -1.5%

2014 and later -2%

Are You Eligible to Participate?

• You must be an eligible professional whose estimated allowed Medicare Part B charges for the e-prescribing measure codes are at least 10% of their total Medicare Part B allowed charges

• Example: – Eligible professional has $100,000 in estimated allowed

Medicare Part B charges– At least $10,000 of charges must be based on the HCPCS

codes that are in the denominator of the E-prescribing Incentive Program measure

“Qualified” eRx Application

1. Generate a complete medication list that incorporates data from pharmacies and benefit managers (if available)

2. Select medications, transmit prescriptions electronically* using the applicable standards, and warn the prescriber of possible undesirable or unsafe situations

3. Provide information on lower-cost, therapeutically-appropriate alternatives (for 2009, tiered formulary information, if available, meets this requirement)

4. Provide information on formulary or tiered formulary medications, pt. eligibility, & authorization requirements received electronically from the patient’s drug plan*

MIPPA Changes 2009 -> 2010Item 2009 2010 (subject to change)

Reporting denominator

Specific codes for office E&M: 90801-9, 92002, 92004, 92012, 92014, 96150-2, 99201-5, 99211-5, 99241-5, G0101, G0108-9

Modify to include SNF and home care: add 99304; 99305; 99306; 99307; 99308; 99309; 99310; 99315; 99316; 99341; 99342; 99343; 99344; 99345; 99347; 99348; 99349; 99350; and 90862

Remove: 99241-99245 (outpatient consultation) from list at left

Reporting numerator

One of 3 G-codes: G8443 (all scripts eRx), G8445 (no scripts written), G8446 (some paper/phoned for various acceptable reasons inc. pt. request, State or Fed law, pharmacy unable to receive, controlled drugs).

Modify G8553: at least 1 Rx for the visit billed was electronically generated and transmitted with a qualified eRx system (Faxes do not qualify); eliminate the three older codes (G8443, G8445, G8446). G-code must be billed on same claim submission as denominator code if claims-based reporting.

“Successful e-prescriber”

>50% of reportable claims include an eRx g-code

Report G8553 25 times during 2010

Successful e-prescriber reporting

Claims-based reporting (g-code on same claim as E&M code)

1) Claims-based reporting

2) Registry reporting

3) “Qualified” EMR reporting

MIPPA for Group Practices• New for 2010

– Practices >200 providers will be able to apply for MIPPA incentives as a practice

– For 2010, practice must also report PQRI to report e-prescribing as a group

– 10% E&M threshold met as a group– Report G8443 with 2500 eligible visit claims for a 200 prescriber

group (50% of 200 providers, times 25 G8443 reports/provider)– Unclear if individual prescribers must also report– Report by claims, registry, or EMR

ARRA

• All you need to know (so far)”– “Meaningful Use”

• Final rule due Spring 2010• http://healthit.hhs.gov/portal/server.pt/gateway/

PTARGS_0_11113_872719_0_0_18/Meaningful%20Use%20Matrix.pdf

Meaningful Use Matrix

http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11113_872719_0_0_18/Meaningful%20Use%20Matrix.pdf

Meaningful Use Incentives by Adoption Year

10

Meaningful User 2009 2010 2011 2012 2013 2014 2015 2016

Total Incentiv

e

2011$

18,000$

12,000$ 8,000

$ 4,000

$ 2,000

$ 44,000

2012$

18,000$

12,000$

8,000$

4,000$

2,000$ 44,000

2013$

15,000$

12,000$

8,000$

4,000$39,000

2014$

12,000$

8,000$

4,000$ 24,000

2015 +$

Penalties

Medicaid Incentives for Physicians and Hospitals

Medicare Incentives for Hospitals

Medicare Hospital Incentives

Medicare Hospital Payout Example

Questions?

Peter N. Kaufman, MDChief Medical Officer

DrFirst