The Centers for Medicare & Medicaid Services (CMS) recently began distributing letters pertaining to 2016 penalties under the Physician Quality Reporting System (PQRS). The recipients—either individual eligible professionals (EPs) or group practices registered for the 2014 PQRS group practice reporting option (GPRO)—were informed that they did not satisfactorily report 2014 PQRS quality measures as needed to avoid the 2016 negative 2% PQRS payment adjustment on all 2016 Medicare Part B Physician Fee Schedule payments.
In addition to this 2% penalty, providers in groups with more than 10 eligible professionals will be subject to an additional 2% penalty under the Value-Based Payment Modifier (VBM) next year for failing to satisfy PQRS reporting requirements.
In these letters, CMS also informed providers that if they believed the determination of their payment adjustment was made in error, they could submit a request for an informal review during the next 60 days. (See here for more details.)
Impact for NextGen Healthcare Clients:
- Clients who believe they successfully reported the 2014 PQRS measures using NextGen® Health Quality Measures (NextGen HQM) or another reporting tool have until November 9, 2015 to submit a request for CMS to investigate incentive eligibility and/or payment adjustment determination.
- If you did not report 2014 measures as required, we urge you to take the necessary steps to do so for 2015 and avoid additional penalties in 2017.
- NextGen HQM is available to all clients for reporting quality measures, including PQRS and MU clinical quality measures. To sign up for NextGen HQM services, simply open a support incident for “HQM install”.
- A complimentary “PQRS 101” webinar is available on Knowledge Exchange to help you get started with PQRS reporting. (Search for “PQRS 101”)
- NextGen® Physician Consulting Services offers individualized assistance with PQRS reporting (contact your NextGen Healthcare sales representative for information).