Audiology MIPS measures are most commonly reported via the CMS-1500 claim form (sample [PDF]). Audiologists add Medicare quality codes to the claim form to report the measures to CMS.
To report, you’ll need to
- know the CPT codes in the measures,
- perform the actions of the measure, and
- include the appropriate quality code on the same claim form as the associated CPT code for the measure(s).
Satisfactory reporting is based on the number of patients for whom you provide a service represented by one of the CPT codes (or, in the case of Measure #261, the CPT/ICD-10-CM combination) that do not meet the exclusion criteria. When the CPT code is billed on the claim form, the appropriate measure codes must also be reported in Box 23D on the CMS 1500 claim form—similar to what would be done for a billable service. If the chosen CPT (or CPT/ICD-10-CM combination) code is not listed in the measure requirements, you do not report on that measure—and you will not be penalized.
Steps for Reporting MIPS Measures
The following three-step reporting guide was developed by the AQC for audiologists:
- Step 1: Review patient eligibility and codes for each measure.
- Step 2: Fill out the CMS-1500 claim form.
- Step 3: Meet CMS’s minimum reporting requirements.
2020–2021 Reporting Requirements
CMS requires providers to report at least six measures for a minimum of 60% of the eligible Medicare patient visits in order to avoid future penalties.
To avoid a MIPS payment penalty in 2022, in 2020 audiologists must successfully report measures on 70% of eligible patients.