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.
- Documentation of the patient's current medications for 50% of the
eligible patient visits for evaluations
to a physician for 50% of the patients that report or are diagnosed with
- 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 payable service.
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 [email protected],
or Lisa Satterfield, ASHA's director of health care regulatory advocacy, at [email protected].