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.