The Centers for Medicare & Medicaid Services (CMS) has released
a Physician Quality Report System (PQRS) 2015
Payment Adjustment Tip Sheet [PDF] to assist providers of Part B Medicare
services in avoiding the penalties that will apply to all payments in 2015 if
2013 reporting requirements are not met.
PQRS applies to all private- and
group-practice audiologists and speech-language pathologists who submit claims
for Medicare Part B beneficiaries. In order to avoid the -1.5% payment
adjustment assessed to all claims in 2015, audiologists and speech-language
pathologists need to report at least one valid measure through claims or a
registry for the calendar year 2013. One valid measure refers to a
measure applicable to the beneficiary that is submitted on a payable claim or
one measure submitted via a CMS-approved registry, such as ASHA's National
Outcomes Measurement System.
PQRS was initiated as
a volunteer, incentive-driven reporting system in 2007 and has subsequently
realized annual decreases in the incentive payment. Incentives for the 2013 and
2014 calendar years are 0.5% on all Medicare Part B claims submitted under a
private or group practice and an individual rendering provider's National
Provider Identification (NPI) when certain benchmarks are achieved. The Patient
Protection and Affordable Care Act (ACA) requires participation in PQRS for 2015
and subsequent years by implementing negative payment adjustments on claims for
covered professional services submitted for rendering providers who have not met
reporting standards. Through regulation, CMS requires that the 2015 adjustment
is based on 2013 participation; the 2016 adjustment is based on 2014
participation, and so forth. In the 2013 Medicare Physician Fee Schedule Final
Rule, CMS determined that one valid, successful reporting attempt would exempt
providers from the 2015 penalty. The requirements for 2014 are more stringent,
requiring for claims-based reporting that at least three measures are reported
for 50% of the individual provider's Medicare caseload. Further details for 2014
reporting requirements are pending issuance of the 2014 Medicare Physician Fee
Schedule Final Rule, expected in early November 2013.
speech-language pathologists can meet the 2013 participation requirement by
submitting codes on Medicare Part B claims specifically for PQRS. The functional
outcomes reporting requirements for all Medicare Part B therapy services do not
satisfy the PQRS reporting requirements. All PQRS submissions must be completed
for dates of service in calendar year 2013 on payable claims processed prior to
February 28, 2014.
For more information, contact Lisa Satterfield, MS,
CCC/A, director of health care regulatory advocacy, at [email protected].