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 has issued the 2015 1.5% penalties based on participation in 2013. If PQRS quality codes were not reported on a minimum of 50% of eligible visits 2014, providers will be issued a 2% penalty on all claims in 2016.
Speech-language pathologists (SLPs) who provide services to Medicare Part B beneficiaries through private or group practices or university clinics that submit claims on the CMS 1500 Health Insurance Claim Form [PDF], electronically or on paper, are required by PQRS to participate in 2015 in order to avoid a 2% penalty on all Medicare claims in 2017. Providers practicing in critical access hospitals (CAHs) that have elected Method II billing must also participate; SLPs should check with their hospital administration to determine if the hospital is a Medicare-approved CAH and the elected method of billing.
Please note that PQRS participation starts over each calendar year. If you did not participate in 2014, you can participate in 2015 and avoid penalties on 2017 claims. In 2016, the Value-Based Payment Modifier program will be included with the PQRS program. If audiologists do not meet 2016 benchmark requirements for PQRS in 2016, the addition of the value-based modifier may result in a 6% decrease to all 2018 Medicare claims. It is important to understand that rules, benchmarks, and penalties change annually. Please follow the ASHA Leader, subscribe to ASHA Headlines, or register with your Medicare Administrative Contractor (MAC) to receive the most current information regarding PQRS.
Reporting on the Claim Form
Participation in PQRS requires adding specified PQRS codes to claims for every qualifying visit. When a claim for a Medicare Part B beneficiary is submitted for speech-language treatment, swallowing treatment, or cognitive therapy, a PQRS G-code related to the documentation of medication 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 provide functional outcomes on the claim. Participation in PQRS prevents a 2% reduction in payment from being assessed in 2017.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.