Q's and A's: Physician Quality Reporting System (PQRS)

Many of you may be hearing a lot about PQRS. If you’ve received notification about this, here’s some information that may help clear things up:

What is PQRS? 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 outpatient Medicare Part B beneficiaries (does not apply to Part B hospital and skilled nursing facilities) must participate in the Medicare Physician Quality Reporting System (PQRS) program to avoid deductions to claims in 2015.

When should we start? Audiologists can start at any time. However, until December 31, 2014, a 0.5% bonus will be given for all Medicare eligible charges when reporting on a minimum of three (3) measures for all eligible cases. Beginning on January 1, 2015, the Centers for Medicare and Medicaid Services (CMS) has proposed that the current voluntary incentive program will terminate and a payment adjustment will be assessed if eligible professionals do not report on at least one (1) quality measure. In 2015, for those who did not report on eligible measures in 2013, a 1.5% payment reduction on each Medicare claim will be retained by Medicare. Similarly for those who don't report on at least one measure in 2014, a payment deduction of 2.0% on each claim submitted for payment will be retained by Medicare contractors in 2016. Thus, there is a two year delay in assessing the payment reduction, which will technically be applied to each claim in 2015 and 2016, respectively.

What do we do? Reporting is easy! Any time you perform a CPT code, you must determine if there is a corresponding G code and report it 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 one of the combinations of CPT code and ICD-9 code if there is an ICD-9 indicated. If the CPT code is reported with the ICD-9 code, the appropriate G-modifier code must be on the claim and placed in box 24 D on the CMS 1500 claim form.

For use in TIMS:

One must enter these new G-Modifier codes in TIMS as new CPT codes. When the transactions are created, they will be entered and selected as a CPT code and not as a modifier, with a price of $.01. This amount is adjusted at the payer.

Please contact TIMS Audiology support with any questions at 800-763-0308.

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