The Patient Protection and Affordable Care Act (ACA)
Physician Quality Reporting System (PQRS)
Patient Protection and Affordable Care Act
What This Is
The Centers for Medicare and Medicaid Services (CMS) designed the PQRS to improve the quality of care for Medicare beneficiaries by tracking practice patterns. Since 2007, quality reporting has been voluntary for services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries. The ACA made participation in Medicare's PQRS program mandatory beginning in 2015.
What This Means for SLPs and Audiologists
Audiologists and speech-language pathologists (SLPs) participate when they are enrolled as Medicare Part B providers through private or group practices that submit claims on the CMS 1500 Health Insurance Claim Form, electronically or on paper.
Audiologists can report on three quality measures. SLPs can report on two PQRS quality measures. These measures are reportable via the CMS 1500 claim form with Medicare directed codes. For more information, see Reporting Audiology Quality Measures: A Step-by-Step Guide and Physician Quality Reporting System for Speech-Language Pathologists.
Implementation Time Line
For reporting years 2012 through 2014, audiologists and SLPs can earn an incentive payment equal to 0.5% of allowed charges. However, providers who are not successfully participating in PQRS by 2013 will have their 2015 Medicare reimbursement decreased by 1.5%. In 2016, the payment decrease will be 2%.
ASHA participates in weekly conference calls with CMS and the Medicare PQRS contractor and is collaborating with several audiology organizations regarding National Quality Forum measure endorsement.