The Physician Quality Reporting System (PQRS) is a program through the Centers for Medicare and Medicaid Services (CMS) designed to improve the quality of care to Medicare beneficiaries by tracking practice patterns.
Who Should Participate?
Audiologists who bill for services provided for outpatient traditional Medicare Part B beneficiaries on the CMS 1500 form, or its electronic equivalent, must participate in the Medicare Physician Quality Reporting System (PQRS) to avoid deductions on all Medicare payments. This applies to audiologists in:
- Independent practices
- Otolaryngology offices
- University clinics
- Anywhere audiologists are billing with their individual NPI as the rendering provider of the service on the CMS 1500 claim form
The Group Practice Reporting Option (GPRO) may exempt audiologists from the penalties, if the following qualifications are met:
- Practice includes physician(s)
- Physician(s) has enrolled with CMS in the GPRO option
- Participating physicians meet all of the requirements for reporting the measures, including documentation of medication, smoking cessation, immunizations, diabetes prevention, and other health screenings
Audiologists can screen for their potential reporting option by utilizing the eHealth Eligibility Assessment Tool. Audiologists in practices with physicians should consult with their administrators regarding their participation in the PQRS program.
Audiologists may be required to report PQRS if the hospital clinic is enrolled as a group practice and does not bill under the hospital NPI or Outpatient Prospective Payment System (OPPS). Audiologists in hospitals need to check with their billing department or administration regarding PQRS eligibility and participation requirements.
When Should Audiologists Participate?
Audiologists should start immediately in order to avoid the 2% penalty to be retained on all 2018 claims for failure to report on 2016 eligible measures.