Medicare Ups 2016 Quality Reporting Requirements Reimbursement-related expectations for efficiency, quality and outcomes will be even greater in 2017. Bottom Line
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Bottom Line  |   March 01, 2016
Medicare Ups 2016 Quality Reporting Requirements
Author Notes
  • Lisa Satterfield, MS, CCC-A, associate director of ASHA’s National Center for Evidence Based Practice, is former director of ASHA health care regulatory advocacy. lsatterfield@asha.org
    Lisa Satterfield, MS, CCC-A, associate director of ASHA’s National Center for Evidence Based Practice, is former director of ASHA health care regulatory advocacy. lsatterfield@asha.org×
Article Information
Practice Management / Bottom Line
Bottom Line   |   March 01, 2016
Medicare Ups 2016 Quality Reporting Requirements
The ASHA Leader, March 2016, Vol. 21, 28-29. doi:10.1044/leader.BML.21032016.28
The ASHA Leader, March 2016, Vol. 21, 28-29. doi:10.1044/leader.BML.21032016.28
In its efforts to shift to reimbursement models based on quality and outcomes, Medicare has increased the quality measure reporting requirements for audiologists and speech-language pathologists who treat Medicare beneficiaries in private practices, group practices and university clinics.
Audiologists and SLPs who don’t participate in the Physician Quality Reporting System (PQRS) in 2016—or fail to report measures for at least 50 percent of eligible Medicare patient visits—will be penalized 2 percent on their 2018 Medicare claims.
What are the measures for audiologists?
Audiologists are eligible to report on six measures, and must report on all six for at least 50 percent of eligible Medicare beneficiaries. Eligibility is based on the patient’s reason for the visit, as each measure is tied to specific procedure codes, such as 92540 (vestibular evaluation) or 92557 (audiologic evaluation).
The measures that audiologists must report are:
  • #130: Documentation/verification of medication in the medical record.

  • #134: Screening for depression for tinnitus patients, with a follow-up plan for positive findings.

  • #154: Falls risk assessment.

  • #155: Falls risk plan of care.

  • #226: Tobacco use screening and cessation counseling.

  • #261: Referral of patients with chronic or acute dizziness.

PQRS bridges the transition from payment for procedure (the current fee-for-service system) to payment for quality and outcomes.

What are the measures for SLPs?
SLPs are eligible to report on three measures, and must report on all three for at least 50 percent of eligible Medicare beneficiaries. Eligibility is based on the patient’s reason for the visit, as each measure is tied to specific procedure codes, such as 92507 (speech-language treatment) or 92523 (speech-language evaluation).
The measure that SLPs must report are:
  • #130: Documentation/verification of medication in the medical record.

  • #131: Standardized pain assessment with a follow-up plan for positive findings.

  • #226: Tobacco use screening and cessation counseling.

How do I get started on PQRS?
If your work setting is not familiar with PQRS and its requirements, discuss participation with management or administration. To participate, take the following steps:
  • Learn which procedure codes are included for each of the measures.

  • Determine if reporting for that measure is required for every visit or annually.

  • During the patient’s visit, perform the appropriate measures.

  • Choose the appropriate G-code that indicates that you performed the measure or that the patient did not qualify (even though you are billing for an eligible procedure). For example, a patient already receiving physician treatment for dizziness would be an acceptable exception for Measure #261 (referral for dizziness). Each measure has approved exceptions for reporting based on the patient’s status, but the exceptions must be noted and reported to avoid the penalties.

  • Include the G-code on the claim form.

How do I make sure I hit the 50-percent benchmark?
Completing the measure—not just reporting on it—counts toward the 50-percent minimum reporting requirement. Measure #130, for example, requires audiologists and SLPs to document medications in the medical record. Your reporting must indicate that you did, indeed, document the medications to count in the benchmark. Reporting the option that you did not document the medications does not count toward the 50-percent benchmark.
In addition, each measure must be reported at the minimum 50-percent positive rate. If you report on 100 percent of patients for medication documentation but only 20 percent for tobacco screening, you will incur a 2-percent penalty in 2018.

Significant expansions in quality and outcome measurement are anticipated over the next three to five years: Penalties will ramp up to 9 percent for substandard or no performance, and providers who report outcomes through a registry or who participate in alternative payment models will receive payment increases.

This sounds confusing!
ASHA offers more information on the procedures assigned to each measure. The Centers for Medicare and Medicaid Services also has a tool to help providers with measure details.
How does this system capture quality?
Congress and policymakers have been touting the importance of efficient, cost-effective, quality health care, but have struggled to design a system that measures and implements the changes. PQRS bridges the transition from payment for procedure (the current fee-for-service system) to payment for quality and outcomes.
Measuring processes—what the clinician does—is a relatively easy way to capture one factor that influences quality. Medicare officials continue to work on developing meaningful ways to capture outcomes, efficiency and quality of care. The reporting requirements will increase, and ASHA is monitoring and responding to those changes.
Significant expansions in quality and outcome measurement are anticipated over the next three to five years: Penalties will ramp up to 9 percent for substandard or no performance, and providers who report outcomes through a registry or who participate in alternative payment models will receive payment increases.
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March 2016
Volume 21, Issue 3