Reporting Audiology Quality Measures: An Overview
Medicare Part B Physician Quality Reporting System (PQRS)
What is PQRS?
The Physician Quality Reporting System (PQRS) is a program through the Centers for Medicare and Medicaid Services (CMS) designed to improve the quality of care to Medicare beneficiaries by tracking practice patterns.
Who should participate?
Audiologists who bill outpatient Medicare Part B beneficiaries (with the exception of Part B beneficiaries in hospitals and skilled nursing facilities) must participate in the PQRS program to avoid deductions to claims. This applies to audiologists in independent practices as well as those providing services in otolaryngology offices or university clinics, using their individual National Provider Identification (NPI) or Taxpayer Identification Number (TIN) on the claim form as the rendering provider of the service.
When should we start?
Audiologists should start immediately in order to avoid the 2% penalty in 2016 for non-reporting on 2014 eligible measures. CMS retired measure #188 Referral for Otologic Evaluation for Patients with Congenital or Traumatic Deformity of Ear, effective January 1, 2014, leaving one audiology specific measure, Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness (measure #261) on which to report. There are two other measures on which audiologists may report, as noted below.
Until December 31, 2014, a 0.5% bonus will be given for all Medicare eligible charges when reporting on applicable measures for 50% of eligible visits. In response to legislation, the CMS will terminate the incentive program at the end of 2014. Eligible professionals who did not report on at least one (1) quality measure in 2013 will incur a 1.5% decrease in payment on all Medicare claims submitted in 2015. Those professionals who choose not to report according to the minimum requirements in 2014 will incur a 2% penalty on all claims filed in 2016.
What do we do?
Reporting is easy! Any time you perform a CPT code in the tables in the Step-by-Step Guide, you must determine if there is a corresponding G-code and report it on the claim form. Satisfactory reporting is based on the number of patients for whom you provide a service that is represented by one of the CPT codes or one of the combinations of CPT codes and ICD-9 codes when and ICD-9 is indicated, as in the case for Measure #261 (Referral for Otologic Evaluation with Acute or Chronic Dizziness). Note that the ICD-9 coding system will transition to the ICD-10 coding system on October 1, 2014. If the CPT code is reported with the ICD-9/10 code, teh appropriate G-code must also be reported and placed in box 24D on the CMS-1500 claim form. If the ICD-9/10 code chosen is not listed in the measure requirements, you do not report on that measure and you will not be penalized for not reporting.
Measure #130 (Documentation of Current Medications in the Medical Record) does not included ICD-9/10 codes, but can assist in avoiding payment deductions in Medicare claims. Documentation of current medications is viewed as a best practice for many clinicians. This measure should be reported each visit a patient is seen for the qualifying CPT code procedure. Measure #134 (Screening for Clinical Depression and Follow-UP Plan) should only be reported if you routinely utilize a depression screening tool and is within your state scope of practice. You will not be penalized for not reporting on Measure #134. If used, this measure should be reported once per reporting period.
The specifications of the measures are available in the Step-by-Step Guide. Further detailed specifications with applicable codes are available on the CMS website.