CODING AND REIMBURSEMENT | Important Changes to Quality Reporting for 2017

By Kate Thomas

This article is a part of the March/April 2017, Volume 29, Number 2, Audiology Today issue.

Did you know that at the end of 2016, the Physician Quality Reporting System (PQRS) ended and was replaced by CMS’ new Quality Payment Program (QPP)? This means that 2016 was the final year in which providers, including audiologists, were eligible to participate in the PQRS program.

The year 2017 marks the first performance year for CMS’ new QPP, with payment adjustments being distributed in 2019. In the first two years of the Merit-Based Incentive Payment System (MIPS), the only providers considered as eligible professionals to participate in the program are the following—physicians, physician assistants, certified registered nurse anesthetists, nurse practitioners, clinical nurse specialists, and groups that include such professionals. Audiologists are ineligible to formally participate in the new QPP during the first two years of the program (2017 and 2018); however, there are opportunities for voluntary or practice reporting.

What Do Audiologists Need to Know About the End of PQRS and the Transition to MIPS/ Advanced Alternative Payment Models (APMs)?

It is important to note that audiologists are ineligible to participate in MIPS for at least the first two years (2017, 2018). The Secretary of the U.S. Department of Health and Human Services (HHS) has the authority to include other professionals, including audiologists, beginning in 2019. This means that audiologists will not be required to report on anything in 2017, but will have the option to “practice” reporting on measures through MIPS.

What Are the Options for Participation in the QPP?

There are two pathways for participation in the QPP. The first is through the MIPS, and the second is through APMs. MIPS streamlines existing CMS quality programs including PQRS, the Value Modifier Program (VM) and the Medicare Electronic Health Record (EHR) Incentive Program. Under MIPS, payment adjustments will now be calculated across four categories—quality, clinical practice improvement activities, advancing care information, and resource use.

An APM is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. CMS anticipates that most providers will participate in the QPP through MIPs in the initial years of the program, hence the Academy’s focus on this pathway.