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Information about PQRS Penalty Letters Affecting 2016 Medicare Reimbursement

Information about PQRS Penalty Letters Affecting 2016 Medicare Reimbursement

The Physician Quality Reporting System (PQRS) penalty letters for 2014 (affecting 2016 Medicare reimbursement) have been sent out.  If you have not received your letter, please go to QualityNet web site to view your performance/feedback report.

In order to avoid the 2% reduction in traditional Medicare reimbursement in 2016, audiologists would have needed to report the following on at least 50% of eligible beneficiaries in 2014:

  • Measure #130 (Documentation of current medications in the medical record) or Measure #134 (Screening for depression)
    • Audiologists are eligible to report Measure #130 if they perform one or more of the following procedures:
      • 92541
      • 92542
      • 92543
      • 92544
      • 92545
      • 92547
      • 92548
      • 92557
      • 92567
      • 92568
      • 92570
      • 92585
      • 92588
      • 92626
    • Audiologists are eligible to report Measure #134 if they perform:
      • 92625
    • If audiologists report on a measure the reporting must report a positive outcome (G8427 or G8430 for Measure #130 or G8431, G8510, G8433 or G8940 for Measure #134) for it to apply to avoiding a penalty.
    • Measure #130 must be reported at every patient visit.
    • Measure #134 and #261 must be reported at least once per calendar year.
  • Measure #261 (Referral for acute of chronic dizziness)
    • Audiologists are eligible to report Measure #261 if they perform one or more of the following procedures and they yield a diagnosis of dizziness (780.4) or benign paroxysmal positional vertigo (386.11):
      • 92540
      • 92541
      • 92542
      • 92543
      • 92544
      • 92545
      • 92546
      • 92547
      • 92548
      • 92550
      • 92557
      • 92567
      • 92568
      • 92570
      • 92575
    • If audiologists report on this measure the reporting must have a positive outcome (G8856 or G8857 for Measure #261) for it to apply to avoiding the penalty.
    • This measure must be reported at least once per calendar year.

If you believe and have proof that you were assessed a penalty in error, please file an appeal no later than 11:59 PM EST on November 23, 2015. Appeals can be filed at here.

(Note) CMS has extended the deadline for the PQRS informal review process to December 11th

The Audiology Quality Consortium (AQC) is in the process of determining if any of the penalties applied have been processed in error.  We are just beginning this examination now that we are aware of how the penalties are being assigned.  We will inform members of the outcome once we have more information.  Please still file an appeal regardless of the inquiry being completed by the AQC

Also of Interest