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 providers.
Audiologists can report on four quality measures that call for a referral of patients to a physician after an audiologic assessment concludes that (a) one of four conditions is present and (b) the patient is not currently under the care of a physician for that condition.
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.
The National Outcome Measurement System (NOMS) is an approved registry through which eligible SLPs can report on PQRS quality measures. SLPs in private practice who provide services to adult Medicare Part B stroke patients can report on eight approved NOMS Functional Communication Measures (FCMs).
Eligible SLPs who wish to participate in the PQRS program should complete the online registration form.
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. With an active registry through NOMS, ASHA plays a key role in collecting submissions from participating SLPs and forwarding them to CMS.