Gorback’s Thoughts by Michael Gorback MD

I was going over the rules for Medicare e-prescribing. I have reproduced the eligibility requirements below. The first thing you'll notice is that CMS hired former IRS employees to write the rules for e-prescribing.

"To be eligible for the incentive in 2009, 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."

The applicable codes are all E&M, and that has to add up to 10% of your total Medicare billing for you to qualify for the bonus. I do not qualify for the bonus and I doubt any procedure-based doctor will. My Medicare E&M encounters only generate 5% of my total Medicare bills.

In reality this is a bonus for internists, pediatricians, etc. Fine with me - you guys get the short end of the stick anyway when it comes to reimbursement. More power to you. However, masochistic fool that I am I kept reading anyway and found a very interesting set of rules that I think will help you all maximize your bonus. The return on investment is infinite because it costs you nothing and you still get the bonus.

Without further ado, here is my holiday gift to those of you who want the bonus but are worried about the cost of implementation:

1. Code G8445 tells CMS that you saw a patient but didn't write any scripts. You still get e-prescribing credit for submitting this code.

2. Code G8446 tells CMS that you wrote a narcotic script or other script that could not be e-prescribed, that the patient requested a written script or a called-in script, or that the receiving pharmacy couldn't accept e-prescribing.

3. You only have to submit 50% of the encounters.

Conclusion: By being selective and using these two codes you can meet all of the criteria for the bonus without EVER doing an electronic prescription.

Happy Festivus to all!

Diversion

jPatients who are "narc seeking" are always a problem to a medical office. They cause angst to the doctors who see them as well as drive the staff crazy. I do prescribe narcotics to patients who need them but I am very careful in the screening process. In almost every issue of the Placebo Journal we publish a story for our "Those Darn Narc Seekers" section that has truly enlightened me to the many devious ways these patients try to score drugs from their physicians. The stories are creative, funny and scary. More than that, however, is that these stories are real as "narc seekers" continue to divert their drugs onto the street. For example, two-thirds of people who died from overdoses of legal pills in West Virginia had no prescription for the drugs that killed them. It seems it is becoming an epidemic in the rural areas. The article highlighted above "urged doctors to strictly follow guidelines for managing narcotics. Such guidelines often involve contracts in which patients agree to strict monitoring in order to get the drugs." That is all well and good but to have the capacity to monitor the patient and the urine tests monthly is costly and time consuming. On the other hand, physicians can get sued for NOT treating pain. We are damned if we do and damned if we don't. I think the best way to help each other as docs is to share our "narc seeker" stories. All kidding aside, I think it is one of the most educational parts of the Placebo Journal and no other medical publication has anything like it. If you have a great "narc seeker" story then send it to me here using this link:

SUBMIT STORY HERE

Make sure you paste your story in the large box and fill out the other stuff as well. All stories that get published will get a free subscription to the Placebo Journal and a free prescription of Percocet. Okay, that last part was a joke.