American Speech-Language-Hearing Association

Reminder: Medicare Providers Avoid Payment Deductions!

(September 9, 2013)

The Centers for Medicare & Medicaid Services (CMS) has released a Physician Quality Report System (PQRS) 2015 Payment Adjustment Tip Sheet [PDF] to assist providers of Part B Medicare services in avoiding the penalties that will apply to all payments in 2015 if 2013 reporting requirements are not met.

PQRS applies to all private- and group-practice audiologists and speech-language pathologists who submit claims for Medicare Part B beneficiaries. In order to avoid the -1.5% payment adjustment assessed to all claims in 2015, audiologists and speech-language pathologists need to report at least one valid measure through claims or a registry for the calendar year 2013. One valid measure refers to a measure applicable to the beneficiary that is submitted on a payable claim or one measure submitted via a CMS-approved registry, such as ASHA's National Outcomes Measurement System.

Background

PQRS was initiated as a volunteer, incentive-driven reporting system in 2007 and has subsequently realized annual decreases in the incentive payment. Incentives for the 2013 and 2014 calendar years are 0.5% on all Medicare Part B claims submitted under a private or group practice and an individual rendering provider's National Provider Identification (NPI) when certain benchmarks are achieved. The Patient Protection and Affordable Care Act (ACA) requires participation in PQRS for 2015 and subsequent years by implementing negative payment adjustments on claims for covered professional services submitted for rendering providers who have not met reporting standards. Through regulation, CMS requires that the 2015 adjustment is based on 2013 participation; the 2016 adjustment is based on 2014 participation, and so forth. 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, requiring for claims-based reporting that at least three measures are reported for 50% of the individual provider's Medicare caseload. Further details for 2014 reporting requirements are pending issuance of the 2014 Medicare Physician Fee Schedule Final Rule, expected in early November 2013.

Audiologists and speech-language pathologists can meet the 2013 participation requirement by submitting codes on Medicare Part B claims specifically for PQRS. The functional outcomes reporting requirements for all Medicare Part B therapy services do not satisfy the PQRS reporting requirements. All PQRS submissions must be completed for dates of service in calendar year 2013 on payable claims processed prior to February 28, 2014.

ASHA Resources

For more information, contact Lisa Satterfield, MS, CCC/A, director of health care regulatory advocacy, at lsatterfield@asha.org.


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