American Speech-Language-Hearing Association

Physician Quality Reporting System (PQRS) Reminder for Audiologists and SLPs

(June 25, 2014)

The 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.

Audiologists

  • Documentation of the patient's current medications for 50% of the eligible patient visits for evaluations

and

  • Referral to a physician for 50% of the patients that report or are diagnosed with dizziness

SLPs

  • 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.

Background

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.

CMS Resources

ASHA Resources

For more information on PQRS, contact the CMS QualityNet Help Desk, at 866-288-8912 or via e-mail at qnetsupport@hcqis.org, or Lisa Satterfield, ASHA's director of health care regulatory advocacy, at lsatterfield@asha.org.


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