Audiology Quality Consortium

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Reporting PQRS Measures

Audiology PQRS measures are reportable via the CMS-1500 claim form (sample). Audiologists add Medicare directed 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
  • Include the appropriate CPT code on the claim form

Satisfactory reporting is based on the number of patients for whom you provide a service represented by one of the CPT codes (or the CPT/ICD-10 combination for Measure #261) 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 a billable service. If the CPT (or ICD-10) code chosen is not listed in the measure requirements, you do not report on that measure and you will not be penalized.

Steps for Reporting PQRS Measures

The following 3-step reporting guide was developed by the AQC for audiologists:

  • Step 1: Review the codes for each measure
  • Step 2: Fill out the CMS-1500 claim form
  • Step 3: Meet CMS’ minimum reporting requirements

2016 Reporting Requirements

The Centers for Medicare and Medicaid Services (CMS) requires providers to report at least 9 measures and at least 1 “cross-cutting measure” for a minimum of 50% of the eligible Medicare patient visits in order to avoid future penalties. If an audiologist provides services to less than 15 Medicare beneficiaries in the calendar year, they are exempt from reporting.

Reporting requirements for 2016 include 3 cross-cutting measures (#130, #134, and #226). Because there are not 9 or more measures to choose from, audiologists must report on all 3 cross-cutting measures when eligible to do so. Additionally, all of their Medicare claims are subject to a Measure Applicability Validation (MAV) process that confirms they have positively reported on a minimum of 50% of the eligible Medicare patient visits for the all of available audiology measures.

Steps for Reporting PQRS Measures

  • Step 1: Review Patient Eligibility & Codes for Each Measure
  • Step 2: Fill Out CMS-1500 Claim Form
  • Step 3: Meet CMS’ Minimum Reporting Requirements
  • Example: Reporting PQRS Measures

Audiology Quality Consortium Members

  • American Speech-Language-Hearing Association
  • American Academy of Audiology
  • Academy of Doctors of Audiology
  • Academy of Rehabilitative Audiology
  • American Academy of Private Practice in Speech Pathology and Audiology
  • Association of VA Audiologists
  • Directors of Speech and Hearing Programs in State Health and Welfare Agencies
  • Educational Audiology Association
  • Military Audiology Association
  • National Hearing Conservation Association
  • Contact Us

    CMS PQRS Help Desk
    (Available 8:00 a.m. - 8:00 p.m. Eastern)
    1-866-288-8912
    gnetsupport@sdps.org

     

    Tim Nanof
    Director, Health Care Policy & Advocacy
    American Speech-Language-Hearing Association
    tnanof@asha.org

    Paul K. Farrell, Au.D., CCC-A
    Associate Director, Audiology Practices
    American Speech-Language-Hearing Association
    pfarrell@asha.org

    Kim Cavitt, AuD
    Academy of Doctors of Audiology
    kim.cavitt@audiologyresources.com

    Kate Thomas
    Director of Payment Policy & Legislative Affairs
    American Academy of Audiology
    kthomas@audiology.org

    Disclaimer

    The content contained on this website has been prepared by the Audiology Quality Consortium (AQC) as a service to its readers and the Internet community and is not intended to constitute legal advice. The AQC has used reasonable efforts in collecting, preparing, and providing quality information and material based on currently available information. The AQC does not warrant or guarantee the accuracy, completeness, adequacy, or currency of the information contained on or linked to this website. This information should not be used in place of legal counsel. Reporting within, documentation for, and claims related to the Physician Quality Reporting System are ultimately the responsibility of the provider themselves.

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