The Centers for Medicare & Medicaid Services (CMS) Physician
Quality Reporting System (PQRS) requires minimal participation in
2013 in order for service providers to avoid a 1.5% penalty
assessment on all claims submitted for Medicare Part B
beneficiaries in 2015. There are three options for meeting
- October 15, 2013, is the last day that
audiologists and speech-language pathologists
(SLPs) can register for the
administrative claims-based reporting mechanism. This
mechanism is designed for physicians using group measures. Because
the group measures do not apply to audiologists or speech-language
pathologists, registering for this option provides only a
short-term qualification in 2013 for avoiding the 2015 penalty; it
is not a method that ensures eligibility in future years.
- February 28, 2014, is the deadline for
audiologists and SLPs to submit claims via the
claims-based reporting option [PDF] for Medicare Part B
beneficiaries. One payable claim must be submitted and successfully
paid with a qualifying PQRS g-code for services performed and
rendered under an individual
SLP's National Provider Identifier (NPI) number in 2013 in
order for the service provider to avoid penalties in 2015.
- Prior to the end of 2013, SLPs can avoid
the penalties by participating in the
registry reporting option [PDF] through the
National Outcomes Measurement System. SLPs should allow
adequate time for training, registration, and data collection.
Utilizing NOMS for CMS
function outcome reporting requirements does not
constitute automatic participation for PQRS.
Reporting outcomes to Medicare and other payers is increasingly
becoming a standard tied to payment. PQRS, first mandated in 2007,
is transitioning from a volunteer, incentive-driven reporting
system to a mandatory reporting requirement for all private and
group practice providers submitting fee-for-service claims for
services provided to Medicare Part B beneficiaries. In 2013,
meeting benchmark requirements can result in a bonus payment of
0.5% on all Medicare Part B claims, but non-participation will
result in a 1.5% penalty assessed on all claims submitted under a
private or group practice and an individual rendering provider's
NPI number for 2015. In the 2013 Medicare Physician Fee Schedule
Final Rule, CMS determined that one valid, successful reporting
attempt would exempt providers from the 2015 penalty. The
requirements for 2014 are more stringent and are expected to
increase in subsequent years.
For more information, please contact Lisa Satterfield, MS,
CCC-A, ASHA's director of health care regulatory advocacy, at email@example.com.