Bottom Line: FAQs for the ABCs of PQRS If you treat Medicare-eligible clients, you need to comply now with new outcome reporting requirements—or face future penalties. Here’s what you need to know. Bottom Line
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Bottom Line  |   February 01, 2014
Bottom Line: FAQs for the ABCs of PQRS
Author Notes
  • Lisa Satterfield, MS, CCC-A, is ASHA director of health care regulatory advocacy. ·lsatterfield@asha.org
    Lisa Satterfield, MS, CCC-A, is ASHA director of health care regulatory advocacy. ·lsatterfield@asha.org×
Article Information
Practice Management / Bottom Line
Bottom Line   |   February 01, 2014
Bottom Line: FAQs for the ABCs of PQRS
The ASHA Leader, February 2014, Vol. 19, 30-31. doi:10.1044/leader.BML.19022014.30
The ASHA Leader, February 2014, Vol. 19, 30-31. doi:10.1044/leader.BML.19022014.30
New 2014 rules for Medicare’s Physician Quality Reporting System change what clinicians must report, how—in some cases—they report the measures, and how often they must report. If you provide Medicare Part B outpatient therapy services, you have to comply with the rules now to avoid penalties on your future Medicare reimbursement. Test your knowledge of PQRS with our FAQs.
Q I work in a university clinic. Does PQRS apply to me?
Yes, it does. Audiologists and speech-language pathologists who work in nonfacility settings and bill using the CMS-1500 claim form (or electronic equivalent) for Medicare fee-for-service patients must report PQRS quality measures to avoid future penalties.
Q I thought PQRS was a voluntary program. What if I don’t want to participate?
Up until 2012, PQRS participation was voluntary, and providers who participated received bonus payments. In 2013, however, the Centers for Medicare and Medicaid Services began the transition to a penalty system for non-participation. You don’t have to participate in PQRS—but if you choose not to, you will not receive full payment for Medicare services you bill in the future.
Q What are the penalties, and how do they work?
The penalties apply to your reimbursement in future years, based on when you failed to participate:
  • If you did not report on at least one payable claim for one Medicare beneficiary in 2013, all the claims you submit for services you provide in 2015 will be reduced by 1.5 percent.

  • If you do not report on 50 percent of your eligible Medicare patient visits in 2014, your claims in 2016 will be reduced by 2 percent.

Q I did not report in 2013, but have not yet submitted all of my claims. Is there still time to report?
If you have claims to submit for 2013 dates of service, you can submit them—along with the PQRS codes—until Feb. 28, 2014. If you have already submitted all of your 2013 claims, however, you cannot submit PQRS codes for those claims. PQRS codes must be submitted on claims with payable services.
Q I keep hearing that I have to report nine measures for PQRS, but I can only find two or three. How can I report nine measures?
Audiologists and SLPs do not have nine measures to report for PQRS. Audiologists have three measures and SLPs have two.
Because there are not more than nine to choose from, audiologists and SLPs should report every measure that is applicable to their practice.
Q I am an SLP and I already include the G-codes on my claim form. Does that satisfy the PQRS reporting requirements?
No. The functional outcome reporting and PQRS are two separate CMS programs that both use G-codes for reporting. You must report the G-codes specific to the PQRS program to avoid the future penalties.
Q I thought PQRS was just for stroke patients and reported through ASHA’s National Outcomes Measurement System. Is this different now?
Yes, it is different. SLPs may no longer use the NOMS system to report PQRS. CMS removed NOMS functional communication measures from the PQRS program, leaving only two “general” measures for SLPs to report on the claim. The functional communication measures are, however, still aligned with the CMS functional reporting requirements, which is a separate program. For more information on functional outcome reporting and NOMS, visit on.asha.org/medicare-and-noms.
Q How can I learn more about PQRS?
A Feb. 11 live webinar will focus on PQRS participation. The webinar, designed for audiologists and SLPs in private or group practice or university clinics, will be available on demand after the event.
For more information, visit on.asha.org/physician-reporting.
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February 2014
Volume 19, Issue 2