Physician Quality Reporting System for Speech-Language Pathologists
Reporting Quality Measures for Medicare Part B Services
The Centers for Medicare and Medicaid Services (CMS) designed the Physician Quality Reporting System (PQRS) to improve the quality of care for Medicare beneficiaries by tracking practice patterns. The Patient Protection and Affordable Care Act made participation in Medicare's PQRS program mandatory beginning in 2015; penalties are assessed for non-participation and CMS is issuing the 2015 1.5% penalties based on participation in 2013.
Speech-language pathologists (SLPs) who provide services to Medicare Part B beneficiaries through private or group practices that submit claims on the CMS 1500 Health Insurance Claim Form [PDF], electronically or on paper, are required by PQRS to participate in 2014 in order to avoid a 2% penalty on all Medicare claims in 2016.
Reporting on the Claim Form
Participation in PQRS on the claim form is not, at this time, based on the patient diagnosis or condition. When a claim for a Medicare Part B beneficiary is submitted for speech-language treatment, swallowing treatment, or cognitive therapy, a G-code related to medication documentation or pain assessment can be appended to the claim. For specific instructions regarding the claim-based measure, see PQRS Measures Available for SLPs to Report on Claims.
Please note that PQRS participation is a separate initiative from the claims-based outcomes reporting requirement for Medicare Part B therapy services. To receive payment for Medicare Part B services, SLPs must participate in the claims-based system. Participation in PQRS prevents a 2% reduction in payment from being assessed in 2016.The various non-payable G-codes used by CMS are program specific. Reporting in the mandatory claims-based outcomes reporting system does not exempt SLPs from PQRS participation.