American Speech-Language-Hearing Association

Medicare Clarifies PQRS Requirements for Audiologists and SLPs

(February 7, 2014)

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.

Audiologists:

  • 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

SLPs:

  • 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.

Background

The PQRS 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.

CMS Resources

ASHA Resources

For more information on PQRS, contact Lisa Satterfield, ASHA's director of health care regulatory advocacy, at lsatterfield@asha.org.


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