Audiologists and speech-language pathologists (SLPs) who want to
avoid the 2% payment reduction to Medicare claims in 2016 will need to meet the
following requirements in 2014.
- Document or
confirm the patient's current medications for 50% of the eligible patient visits
for evaluation AND
- Indicate a referral to a physician
for 50% of the patients who report or are diagnosed with dizziness
- Document or confirm the patient's current medications for
50% of the eligible patient visits for therapy
PQRS applies to
audiologists and SLPs in private practice, group practice, or university
clinics. At this time, PQRS does not apply to providers in facilities
such as hospitals or skilled nursing facilities. PQRS does not require separate
enrollment-it applies to all providers when claims are submitted with the
audiologist or SLP listed as the provider rendering the service. In order to
participate, audiologists and SLPs must enter in PQRS specific G-codes on the
claim for the payable service. Audiologists and SLPs who do not meet the 2014
requirements will have all payments for procedures performed by them in 2016
reduced by 2%.
ASHA successfully advocated for the removal of screening
for depression (audiologists) and pain assessment (SLPs) from mandatory
reporting. While they remain options, failure to report those measures will
neither result in a payment reduction nor affect the 0.5% incentive for
participation in 2014. Screening for depression and pain assessment should only
be reported if such screening is a standard practice of the clinic and covered
under state licensure scope of practice.
program was initiated as an incentive-based program, but has transitioned to a
penalty-based program based on participation in 2013 and subsequent years.
Satisfactory participation is confirmed in the Measures Applicability Validation
(MAV) process, which linked documentation of medication with screening for
depression and pain assessment, requiring audiologists and SLPs to meet
benchmark requirements for both in order to avoid the future payment reductions.
ASHA, along with members of the audiology community, worked with the Centers for
Medicare & Medicaid Services (CMS) to clarify concerns regarding licensure,
liability, and the limited practice of audiologists' performing a standardized
screen for depression on all patients. Likewise, ASHA discussed the limited use
and applicability of pain assessment by SLPs in private practice. CMS responded
by revising the MAV process to ensure that audiologists and SLPs would not be
penalized for not reporting the measures.
information on PQRS, contact Lisa Satterfield, ASHA's director of health care
regulatory advocacy, at email@example.com.