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, university clinics, and critical access hospitals that submit claims for Medicare outpatient services. Audiologists and SLPs report specified codes on the claim form required for the billable procedures. Rules and measures change annually.
Implementation Time Line
Providers who did not successfully participating in PQRS in 2013 were notified by Medicare of the 1.5% decrease on their 2015 claims. In 2016, the payment decrease will be 2% based on 2014 participation.
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.