Physician Quality Reporting System (PQRS) applies to audiologists and
speech-language pathologists (SLPs) in private practice, group practice, or
university clinics who bill Medicare for outpatient services
(Part B). At this time, PQRS does not apply to providers in facilities, such as
hospitals or skilled nursing facilities. In order to avoid the 2% payment
reduction to Medicare claims in 2016, 2014 claims need to include specified PQRS
codes that indicate the following.
of the patient's current medications for 50% of the eligible patient visits for
- Referral to a physician for 50% of the
patients that report or are diagnosed with dizziness
- Documentation of the patient's current medications for 50% of the eligible
patient visits for therapy
In order to participate, audiologists and
SLPs must enter a PQRS-specific code(s) on the Medicare outpatient claim for the
Audiologists and SLPs can ensure the PQRS codes are
accepted by Remittance Advice Remark Codes (RARCs) that are returned with the
payment. For services provided 1/1/2014-6/30/2014, N365 indicates the PQRS code
was recognized in the system. Effective 7/1/2014, N620 replaces N365. The new
RARC code N620 indicates that the PQRS code(s) was received into the CMS
National Claims History (NCH) database.
Up until 2012,
PQRS participation was voluntary, and providers who participated received bonus
payments. In 2013, however, the Centers for Medicare and Medicaid Services began
the transition to a penalty system for non-participation. Penalties are assessed
on future claims; 2016 services provided by the individuals who did not meet
2014 benchmark requirements will receive a 2% reduction of payment. Benchmarks
for reporting are released annually in the Medicare
Physician Fee Schedule and are subject to change every year.
information on PQRS, contact the CMS QualityNet Help Desk, at 866-288-8912 or
via e-mail at firstname.lastname@example.org,
or Lisa Satterfield, ASHA's director of health care regulatory advocacy, at email@example.com.