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 in group or private practice using their individual National Provider Identification (NPI) or Taxpayer Identification Number (TIN) on the claim form as the rendering provider of the service must participate in the Medicare Physician Quality Reporting System (PQRS) program in 2013 to avoid deductions to all Medicare claims beginning in 2015. Institutional providers, such as those employed in hospitals or skilled nursing facilities, do not participate in PQRS at this time.
When should we start?
Audiologists can start at any time, though penalties will be assessed based on 2013 participation. In order to receive a 0.5% incentive bonus, you must report on a minimum of 50% of eligible cases seen for the calendar year (January 1 through December 31, 2013). Beginning on January 1, 2015, the current voluntary incentive program is scheduled to terminate and a payment adjustment will be assessed if eligible professionals do not report on at least one (1) quality measure from January 1 through December 31, 2013. This means that if you do not report on at least one applicable measure in 2013, a 1.5% payment reduction on each Medicare claim will be retained by the Medicare contractor in 2015.
Correct reporting is based on the eligible patient, not the measure title. Reporting must occur when a patient presents with the ICD-9 code assigned to the measure and the CPT code is performed.
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. For the audiology-specific PQRS measures, reporting is based on the combination of CPT and ICD-9 codes indicated in the Step-by-Step Guide. For these cases, a G-code must be placed in box 24 D on the CMS 1500 claim form for the patient and service provided that triggered eligibility for reporting.
For the two audiology-specific measures, reporting the G-code is required annually for each patient to meet benchmark requirements. If theICD-9 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. In order to ensure accurate reporting, consider incorporating the reporting process with each new patient or first annual follow-up, as appropriate.
Measure #130 (documentation of medications) does not include ICD-9 codes, but can assist in avoiding payment deductions in Medicare claims and is viewed as a best practice for many clinicians. Measure #134 (screening for clinical depression and follow-up plan) should only be reported if you routinely utilize a depression screening tool and it is within your state scope of practice. You will not be penalized for not reporting on Measure #134. If used, these measures should be reported at each visit.
The specifications of the measures are available on the Audiology Quality Consortium (AQC) website under the "Quality Measures" section. Further detailed specifications with applicable codes are available on the CMS website.
The AQC has also developed a step-by-step guide for audiologists reporting on the measures.