On September 26, 2016, CMS announced the availability of 2015 Physician Quality Reporting System (PQRS) Feedback Reports and 2015 Annual Quality and Resource Use Reports (QRURs), and opened the process for providers receiving notifications of payment adjustments under the PQRS and Value-Based Payment Modifier (Value Modifier) programs.
If you believe you were assessed a negative payment adjustment in error, you should request an Informal Review before the November 30 deadline.
Why File an Informal Review for PQRS and the Value Modifier?
- CMS applies a -2.0% PQRS payment adjustment to payments under the Medicare PFS for individual EPs and PQRS group practices that did not meet the criteria for satisfactory reporting in 2015 PQRS.
- CMS will apply a -2.0% or -4% automatic Value Modifier payment adjustment to payments under the Medicare PFS for individual EPs and PQRS group practices that did not meet the criteria for satisfactory reporting in 2015 PQRS.
- CMS will apply a negative or positive payment adjustment for quality and cost performance under the Value Modifier in part based on 2015 PQRS.
- If you participated in 2015 PQRS and believe that a 2017 negative PQRS payment adjustment is being applied in error, or there are inaccuracies in your feedback or QRUR, you can submit an informal review request. To contest PQRS results you will need to file a PQRS Informal Review. To contest Value Modifier performance results you will need to file a Value Modifier Informal Review.
- You can request an informal review of your 2015 PQRS results during the informal review period of September 26 2016 through November 30, 2016.
How to File an Informal Review
- PQRS and Value Modifier Informal Reviews are different and each type of informal review requires filing in different CMS websites.
- Informal Reviews for PQRS are filed in the CMS Quality Reporting Communication Support Page
- Informal Reviews for the Value Modifier are filed in the CMS EIDM System
Informal Review Guides and Help Desks
PQRS:
See the guide 2015 PQRS: 2017 PQRS Negative Payment Adjustment – Informal Review Made Simple and the PQRS Analysis and Payment website
Value Modifier:
Value Modifier Informal Review Request Quick Reference Guide
For PQRS: QualityNet Help Desk
7:00 a.m. – 7:00 p.m. CT
Monday – Friday
E-mail: qnetsupport@hcqis.org
Phone: (866) 288-8912*
TTY: (877) 715-6222
Fax: (888) 329-7377
For QRUR or Value Modifier: Physician Value (PV) Help Desk
8:00 a.m. – 8:00 p.m. ET
Monday – Friday
E-mail: pvhelpdesk@cms.hhs.gov
Phone: (888) 734-6433 (option 3)
See this article in What’s Next for additional information on PQRS Feedback Reports or QRURs and how to take hold of your performance data.