Steps to receive CMS incentives ($44,000) or Medicaid Incentives ($62,000) using Office Medicine:

( This does not guarantee you will receive incentives, however Medicare providers MUST apply for EHR incentives or setup PQRS for e-prescribing  or face reductions in future years )

See e-prescribe section below for alternate PQRS reporting. (not recommended)

1. Make sure you have Office Medicine version 12. loaded on your system.

2. Send us an email at officemedicine@comcast.net so we can review and enroll your PQRS measures and/or provide training if needed.  We will also send you the EMR certification number. Do not register without the certification number.

3. Click the link below and scroll to the bottom of the page and click "Continue", then login using the same password previously used for your NPI registration NPPES or PECOS.

Click Here to Register with CMS and/or Medicaid starting Jan 3, 2011

CMS EHR Help Line Number is (888) 734-6433

4. Follow the demographic and vitals instructions below.

Starting January 1, 2011- Start populating new fields for Language, Race and Ethnicity.

Language:

Race Options:

Ethnicity Options:

You are also required to record the date of death and preliminary cause of death.

5. Enter Vitals Information for BP, BMI, Patient Advice, Smoking Status and other measures for all applicable patients.  ( VS Template as setup by Office Medicine Staff).

6. E-prescribe Rx.

7. Meaningful use is satisfied after 90 days. Please take note that Meaningful Use is for ALL PATIENTS regardless of payer - Not just Medicare patients.

( Note: Upon successful results DMSI will bill for a portion of the ONC certification fee )

IMPORTANT: EVEN IF YOU ARE USING THE CERTIFIED EHR, YOU MUST CONTINUE CLAIMS OR REGISTRY BASED REPORTING OF ALL PQRI/PQRS PROCEDURES, INCLUDING E-PRESCRIBE, AS THE EHR AND PQRS SYSTEMS AT CMS ARE NOT LINKED YET!

Billing and reporting for e-prescribe incentives.

 ( Alternative to Meaningful Use - You must e-prescribe 25+ patients before 06/30/2011 or face Medicare reductions in 2012)

STEP 1: Did you bill one of the CPT or HCPCS G-codes listed in Table above for the patient you are seeing? NO: You do not need to report this measure for this patient for this visit. YES: Proceed to Step 2.

STEP 2: You should report only one G-code for 2010-2011 (or numerator code) on the claim you submit for this Medicare patient for this visit. • If ANY of the prescriptions generated for this patient during this visit were sent via a qualified e-prescribing system: REPORT G8553 • If NO prescriptions were generated for this patient during this visit: REPORT NOTHING • If ALL of the prescriptions generated for this patient during this visit were printed or phoned in as required by state or federal law or regulations, due to patient request, or due to the pharmacy system being unable to receive electronic transmission; OR because they were for narcotics or other controlled substances: REPORT NOTHING

Note: G8553 must be defined in the procedure code dictionary with a 0.00 Charge amount and the flag "Q" in the flags field.

Claims-based reporting example: Medicare Part B patient A sees Dr. X for an office visit on January 14. Dr. X generates and transmits 3 eRx prescriptions. Dr. X bills encounter code 99215 and submits quality-data code (QDC) G8553 on the claim. Even though Dr. X generated and transmitted 3 eRx prescriptions, this would count as 1 instance of eRx reporting. If patient A returns to see Dr. X January 28 AND Dr. X generates and transmits 2 eRx prescriptions, bills 99212, and submits QDC G8553 on the claim, this would count as 1 instance of eRx reporting.

NDC Drug Codes:

If you are required to submit insurance claims for injections with an NDC number, place the number in field #5 (NDC/Category ) in the procedure code dictionary.

The number should be entered as "NDC 12345123412". The letters "NDC" must precede the number, followed by the 11 digit NDC drug code.

The NDC drug code must be in the 5 + 4 + 2 number format. - Place a leading zero in front of any number segment so that each portion of the number is the correct number of digits.

Examples: if the NDC number is 14567 876 12  enter the number as NDC 14567087612

                     If the NDC number is  4567 0876 12 enter the number as NDC 04567086712

Hardcopy forms will print the correct format based on payer ex: N14567087612

PQRI INCENTIVE CODES:

Note: Any PQRI billing code must be defined in the procedure code dictionary with a $0.00 Charge amount and the flag "Q" in the flags field #56.

Modifiers used for PQRI must be added to the National Modifier Dictionary or they will be edited out.

National Provider Identifier "only" Information Update  09/01/2009

WARNING:  Recent additions of the Corporation or Group NPI may cause payments to be erroneously paid as "OUT OF NETWORK"  - Check Your Vouchers Carefully.

Notice: On October 1, 2009 many clearing houses will require that all legacy numbers be removed from incoming claims. Please DO NOT remove these numbers from the provider tables. The software will do this for you automatically.

1. If you are receiving any "Corporate Crosswalk Error" you must Authorize your NPI numbers with BCBS EDI by using the web based authorization system or by emailing the spreadsheet from the link below. The login and password of the web based system is your BCBS legacy provider number. https://secure.bcbsm.com/bcnnpi/ or you may elect to load this spread sheet and email to: pedmnpiexcelsubmission@bcbsm.com

    Call (248) 486-2292 for assistance from BCBS-EDI. Web NPI Help: BCBS-EDI NPI Help Page

    You must separately authorize NPI's for all the BCBS categories which may be referred to by BCBS-EDI as:      "BL"  = BCBS,  "CI" = Commercial, "MA" = Medicaid and "BN" = Blue Care Network. Please see the BCBS-NPI letter for more details.

2. Register your NPIs with Rail Road Medicare by calling (866) 899-5227 and request the NPI form. The original forms must be filled out and mailed ASAP.

3. Register your NPI with Health Plus of Michigan and any other carrier that does not go directly through the BCBS, THIN, Availity, Emdeon or Health-Point (Anthem) clearing houses.

To check and verify that the NPI numbers are properly associated with legacy numbers,

Click here to use the National NPI search tool or type "NPI" and <Enter> from the Office Medicine MAIN MENU.

4.   DO NOT REMOVE YOUR LEGACY ID NUMBERS - THE SOFTWARE WILL DO THIS AUTOMATICALLY. 

Loading National Provider Numbers Procedure Steps:

For Attending Physicians – General Information Screen.

1. Under the Dictionary/Tables Maintenance Menu, select Provider File Maintenance
2. Bring up each provider number and enter the NPI numbers
3. Enter the NPI specific for this Physician in field #13 “NPI-Main”
4. Enter the Corporation NPI in field #14.
5. Enter the Personal NPI ( if needed ) in field #15

Attending Physicians – Carrier Specific Information

1. For each insurance company with specific requirements regarding the NPI number, perform the following:
2. Click the “INSURANCE” button under each provider.
3. Select the insurance company code as required.
4. Enter the Taxonomy code in field #10, the Physician NPI number in field #11, and the NPI Group/Corp (if any) in field #12

5. Note: Medicaid requires only the individual NPI - Load this into both field #10 and Field #11.

Note: If your practice has a Tax-ID number - You are required to have a CORP ( level 2 ) NPI number. If your practice has multiple locations, you may need a CORP NPI for each location.

  DO NOT REMOVE YOUR LEGACY ID NUMBERS - THE SOFTWARE WILL DO THIS AUTOMATICALLY. 

For Referring Physicians – General Information Screen.

1. Under the Tables/Dictionary Maintenance menu, select referring physician maintenance.
2. Pull up every referring physician as needed and add the NPI number to field #25 with a qualifier of "XX"

Note: Use the little green drop down arrow to search the NPI national database. Copy the NPI number from the website by highlighting the number and then using "Control C",  close the website and paste the number into field #25 with "Control V"

Escape Key to save this record - Perform on each referring physician as needed.

Tip: If you have hundreds of attending physicians to load, use the "Batch Provider PIN UPDATE" utility program located on the Dictionary Tools Menu.

Facility Codes also require an NPI. Fill in the NPI for each facility in the facility table.

To check and verify that the NPI numbers are properly associated with legacy numbers,

Click here to use the National NPI search tool or type "NPI" from the MAIN MENU.

Billing for e-prescribe incentives

STEP 1: Did you bill one of the CPT or HCPCS G-codes listed in Table above for the patient you are seeing? NO: You do not need to report this measure for this patient for this visit. YES: Proceed to Step 2.

STEP 2: You should report only one e-prescribe G-codes for 2010 (or numerator codes) on the claim you submit for this Medicare patient for this visit. • If any of the prescriptions generated for this patient during this visit were sent via a qualified e-prescribing system: REPORT G8553 • If NO prescriptions were generated for this patient during this visit: REPORT NOTHING.

Note: G8553 must be defined in the procedure code dictionary with a $0.00 Charge amount and the flag "Q" in the flags field.  CMS is requiring that 25 codes be reported for 2010.