Electronic prescribing (e-prescribing) has the potential to reduce medication errors, lower costs, improve process flow, and improve patient safety. In simple terms, e-prescribing involves using technology to generate prescriptions using data entry and electronically delivered information at the point of care.

The educational ePrescribe roadmap and other learning opportunities, including a vendor exhibit and fair, will be available at the upcoming ePrescribe Florida Fall Summit being held November 30 through December 2, 2007 at the beautiful Hilton Resort located across from Downtown Disney in the WALT DISNEY WORLDŽ Resort.  Click here for more information.


NPI Deadline Set
The Centers for Medicare & Medicaid Services (CMS) reports that the vast majority of institutional provider claims are being sent to Medicare with a National Provider Identifier (NPI). The Medicare NPI crosswalk has been in successful operation for all institutional provider claims since June 2007. Given these favorable results, CMS is taking the next step towards full implementation of the NPI in Medicare.

Effective January 1, 2008, your Medicare fee-for-service claims received must include an NPI in the primary fields on the claim (i.e., the billing and pay-to fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI. Claims with only a Legacy provider identifier for the primary fields will be returned as unprocessable. You may continue to include legacy only for the secondary fields, if you choose. Failure to submit an NPI in the primary fields will result in your claim being returned as unprocessable, beginning January 2, 2008. In addition, if you already bill using the NPI/legacy pair in the primary fields and your claims are processing correctly, now is a good time to submit to your contractor a small number of claims containing only the NPI. This test will serve to assure your claims will successfully process when only the NPI is mandated on all claims.


AMA and AARP Call on Senate to Avert Medicare Physician Payment Cuts, Protect Seniors from Steep Premium Increases
A joint television ad from the AMA and AARP began airing this week in select areas of the country and Washington, D.C., to spur congressional action to preserve Medicare patients' access to health care. Over the next two years, Medicare will cut payments to physicians 15 percent, while practice costs increase 20 percent. And since 2000, Medicare patients have seen their premiums double. In the joint TV ad, the AMA and AARP ask, "If doctors are forced to downsize their practices and Medicare premiums rise even higher, how will you get the care you need?"

AMA and AARP are calling on the Senate to take action similar to the House of Representatives, which passed legislation to eliminate $54 billion in excess payments to private insurers offering Medicare Advantage plans. Only one in five seniors is enrolled in Medicare Advantage, but these excess payments to insurers are coming out of everybody's pockets. "By eliminating excess payments to Medicare Advantage plans, Congress can put the savings to good use to stop the next two years of Medicare cuts to doctors and instead update payments to help cover increasing costs, while limiting premium increases for seniors," said AMA Board Chair Edward L. Langston, MD.

Other elements of the joint effort include advocacy at the national level and a series of print ads and opinion pieces in newspapers around the country. (Excerpt from AMA E-Voice)
 

CMS-1500 Paper Claim Form Tips
Effective for claims received on or after July 2, 2007, providers may submit paper claims using only the revised CMS-1500 (08/05). The CMS-1500 (12/90) version should not be submitted and will be returned to the provider. For information on filling out your paper claims, click here.

Advance Beneficiary Notice (ABN) for Medicare Claim Form
For medicare claim forms, remember the following tips regarding advance beneficiary notices:

• Modifier GZ must be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an advance beneficiary notification (ABN) signed by the beneficiary.

• Modifier GA must be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny a service as not reasonable and necessary and they do have on file an ABN signed by the beneficiary.

• All claims not meeting medical necessity of a local coverage determination must append the billed service with modifier GA or GZ.

For more information concerning advance beneficiary notices, click here.

Medicaid Tamper Proof Prescriptions
On Saturday, September 29, 2007, President Bush signed the TMA, Abstinence Education, and QI Programs Extension Act of 2007 delaying the implementation date for all paper Medicaid prescriptions to be written on tamper-resistant paper. Under the new law, as of April 1, 2008, all written Medicaid prescriptions must be on tamper-resistant prescription pads. CMS' guidance on the tamper-resistant law, set forth in an August 17, 2007 State Medicaid Director letter, contains two phases. For the first, a prescription must contain at least one of the three tamper-resistant characteristics in order to be considered "tamper-resistant." For the second, prescriptions must contain all three characteristics. The two-phased approach will still be in effect. At least one of the three tamper-resistant characteristics is required on April 1, 2008. All three characteristics are required on October 1, 2008. All other guidance that CMS has issued on this requirement contained in the State Medicaid Director letter and Frequently Asked Questions will still apply once it is implemented. More info on the CMS guidance to States can be found on the CMS Web site. Even though it has not been strictly enforced, the use of tamper-proof prescription blanks for writing Medicaid prescriptions has been a law in Florida for several years.
 

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