The Centers for Medicare and Medicaid Services (CMS) places great emphasis on outcomes measures that are intended to influence patient-care delivery and current and future provider reimbursement. Currently, CMS has designated nine quality measures that may be reported by audiologists under the merit-based incentive payment system (MIPS). Many of these measures are not specific to audiology and may be reported by other types of medical professionals.
Quality measurement and data collection can help advance the field of audiology as a vital profession by substantiating the quality and effectiveness of the services provided to patients. For this reason, the Audiology Quality Consortium (AQC), made up of nine representative audiology organizations, has focused on the development of audiology-specific measures that could be used for reporting under MIPS.
The AQC’s mission is to:
- Collaborate on the development of audiology quality measures for use in the CMS MIPS and with other health-care payers;
- Monitor the status of audiology quality measures for reporting under MIPS and other health-care payers;
- Respond to proposed rules and measure changes by CMS and other measure owners on behalf of the audiology community;
- Educate audiologists regarding audiology-quality reporting and MIPS requirements.
The AQC member organizations include the following:
- Academy of Doctors of Audiology
- Academy of Rehabilitative Audiology
- American Academy of Audiology
- American Speech-Language-Hearing Association
- 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
Audiology-Specific Outcome Measures
Some considerations for audiology-specific outcome measures were presented to the AQC by members who had encountered a company, Healthmonix, with technical experience in measure and registry development.
Working with Healthmonix, the AQC contributed significant clinical expertise in developing and refining the following measures, which are currently undergoing testing:
- Outcomes of Hearing-Loss Treatment
- Outcomes of Treatment of Benign Paroxysmal Positional Vertigo
- Functional Benefit of a Cochlear Implant: Post-Surgical Outcomes
- Outcomes of Treatment of Subjective Tinnitus
These measures would be optional, offering an alternative to the nine extant measures available in the CMS-designated MIPS measures set for audiology.
The new measures will be available for reporting via the Healthmonix registry system. As such, Healthmonix is the owner of the measures and will be responsible for measure maintenance and updates. It is anticipated that the AQC would continue to be involved in those updates.
Mandatory or Voluntary Reporting?
While outcome-measures reporting is not required in 2021 for the majority of audiologists, voluntary or opt-in reporting is currently available for audiologists who wish to track their quality performance, practice reporting, or formally opt in to the program. Opt-in reporting offers an opportunity to earn a MIPS payment incentive of up to nine percent.
In 2021, MIPS reporting is mandatory if audiologists meet all three of the following requirements:
- $90,000 or more of billed services to Medicare, AND
- Provided services to 200 or more Medicare beneficiaries, AND
- Provided 200 or more distinct procedures to Medicare beneficiaries.
Audiology providers can verify if they are mandated reporters under MIPS by consulting the online CMS 2021 provider eligibility look-up tool using their individual national provider identifier (NPI). If any of the three above requirements are met, voluntary reporting can be performed in an effort to track performance. To do so, registration is required via the CMS enterprise identity management system.
It is anticipated that the 2021 low-volume threshold may change as early as 2022, resulting in more audiologists being considered mandatory participants in MIPS. The AQC wants audiologists to be prepared and have the necessary tools to report measures successfully under MIPS.
The reporting mechanism most widely used by audiologists for quality measures is claims-based reporting, a pathway familiar to the audiologists who participated in the former physician quality reporting system (PQRS). Health-care providers may also report through electronic health record systems (EHRS), when available, and various registries, though these mechanisms are not typically used by audiologists.
For more information on the Medicare quality payment program, participation and reporting pathways, quality measure specifications and reporting requirements, and clinical practice improvement activities, go to the AQC website.
The information provided in this article by the American Academy of Audiology Coding and Reimbursement Committee is to provide general information and educational guidance to audiologists. Action taken with respect to the information provided is an individual choice. The American Academy of Audiology hereby disclaims any responsibility for the consequences of any action(s) taken by any individual(s) as a result of using the information provided, and the reader agrees not to take action against, or seek to hold, or hold liable, the American Academy of Audiology for the reader's use of the information provided. As used herein, the "American Academy of Audiology" shall be defined to include the Academy's directors, officers, employees, volunteers, members, and agents.