Audiologists and speech-language pathologists (SLPs) who want to
avoid the 2% payment reduction to Medicare claims in 2016 will need to meet the
following requirements in 2014.
- Document or
confirm the patient's current medications for 50% of the eligible patient
visits for evaluation AND
- Indicate a referral to a
physician for 50% of the patients who report or are diagnosed with
- Document or confirm the patient's current
medications for 50% of the eligible patient visits for therapy
applies to audiologists and SLPs in private practice, group practice,
or university clinics. At this time, PQRS does not apply to providers
in facilities such as hospitals or skilled nursing facilities. PQRS does not
require separate enrollment-it applies to all providers when claims are
submitted with the audiologist or SLP listed as the provider rendering the
service. In order to participate, audiologists and SLPs must enter in PQRS
specific G-codes on the claim for the payable service. Audiologists and SLPs
who do not meet the 2014 requirements will have all payments for procedures
performed by them in 2016 reduced by 2%.
ASHA successfully advocated for
the removal of screening for depression (audiologists) and pain assessment
(SLPs) from mandatory reporting. While they remain options, failure to report
those measures will neither result in a payment reduction nor affect the 0.5%
incentive for participation in 2014. Screening for depression and pain
assessment should only be reported if such screening is a standard practice of
the clinic and covered under state licensure scope of practice.
The PQRS program was initiated as an incentive-based
program, but has transitioned to a penalty-based program based on participation
in 2013 and subsequent years. Satisfactory participation is confirmed in the
Measures Applicability Validation (MAV) process, which linked documentation of
medication with screening for depression and pain assessment, requiring
audiologists and SLPs to meet benchmark requirements for both in order to avoid
the future payment reductions. ASHA, along with members of the audiology
community, worked with the Centers for Medicare & Medicaid Services (CMS)
to clarify concerns regarding licensure, liability, and the limited practice of
audiologists' performing a standardized screen for depression on all patients.
Likewise, ASHA discussed the limited use and applicability of pain assessment
by SLPs in private practice. CMS responded by revising the MAV process to
ensure that audiologists and SLPs would not be penalized for not reporting the
information on PQRS, contact Lisa Satterfield, ASHA's director of health care
regulatory advocacy, at firstname.lastname@example.org.