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Caring for Medicare patients can net you bonuses in 2011
e-Reports, Jan. 24, 2011
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You have three potential options for securing bonus dollars this year if you participate as a fee-for-service Medicare provider. At least one of those bonuses should be attainable for your practice.

Will it take some effort? Yes, but since penalties will eventually be assessed in these areas, getting on board now will benefit your practice, as well as your patients.

Also, you do have choices about which data to collect – and, at least for the electronic health record (EHR) incentive, you can start preparing this year to jump in next year.

Find essential details about the three options here.


E-prescribing is quick and efficient, especially for refills, and practices usually say they would never return to paper once they make the switch. If Medicare Part B patients comprise at least 10 percent of your payer mix, you can earn bonus dollars even without an EHR. However, a computer and Internet connection are required for e-prescribing. If you have an EHR system, you’ll likely need to purchase additional software.

Your incentive pay for participating in 2011-12 will be equal to 1 percent of your allowed charges. To qualify, you must report for at least 25 unique patient encounters, which does include multiple encounters for one patient.

Reporting is claims based using a “G” code (numerator) and an appropriate e-Rx CPT code (denominator). For a helpful guide, go to www.cms.gov/partnerships/downloads/11399-P.pdf.

To find out if pharmacies in your area accept electronic prescriptions, see here.


Formerly known as the Physician Quality Reporting Initiative or PQRI, the newly re-named Physician Quality Reporting System (PQRS) can earn you an incentive equal to 1 percent of allowed charges, in addition to the e-prescribing bonus.

You can get two bonuses, the PQRS and the e-prescribing bonus in the same year, but not a third bonus – the EHR incentive money.

Participation in PQRS requires the reporting of quality data on measures you can choose, including those on heart disease, asthma, diabetes and more. You must submit the data with your bills using appropriate CPT II or HCPCS G codes.

Find details about this program on the CMS PQRS website.

EHR incentive

While you cannot earn the e-prescribing bonus and the Medicare EHR incentive at the same time, the bigger payout and obvious choice is to strive for the EHR incentive if you plan a technology purchase soon.

Why? As a Medicare provider, you can earn up to $44,000 over five years. During a reporting period you may be eligible to receive incentive pay (subject to an annual limit) equal to 75 percent of your allowed charges, if submitted no later than two months after the year ends. You cannot earn both a Medicaid and Medicare bonus in the same year, but you can earn the EHR incentive this year, as well as the PQRS bonus (see chart).

To succeed, you must not only purchase certified EHR technology but also demonstrate that you are using it in a meaningful way. The Medicare program requires you to legally state through Medicare's secure website – called “attestation” – that you've demonstrated "meaningful use" with your new technology.

Get started on the CMS website.

Medicare bonus chart

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