Physician Quality Reporting System for Audiologists

Reporting Quality Measures for Medicare Part B Services

The Centers for Medicare & 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 50% of the eligible Medicare patients seen in 2014, providers will be issued a 2% penalty on all claims in 2016.

Audiologists 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; audiologists should check with their hospital administration to determine if the hospital is a Medicare-approved CAH and the elected method of billing.

Audiology Quality Consortium

The Audiology Quality Consortium (AQC) comprises representatives from 10 national audiology organizations that are purposed to monitor PQRS and respond to rule and measure changes, collaborate on the development of audiology quality measures, and educate audiologists regarding audiology quality measures and PQRS reporting requirements. Information about current PQRS program requirements, and audiology measures under development for future use can be found on the AQC website.

Reporting on the Claim Form

Participation in PQRS requires adding specified PQRS codes to claims for every qualifying visit. Qualifying visits are determined by the procedures (such as a comprehensive hearing evaluation), and in some cases of dizziness, a diagnosis code. For specific instructions for participating in PQRS see the AQC website.

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, and register with your Medicare Administrative Contractor (MAC) to receive the most current information regarding PQRS.


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