PQRS 2016 Informal Review Process

The Centers for Medicare & Medicaid Services (CMS) sent a reminder on September 9 regarding the informal review process for individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, and group practices participating in the Physician Quality Reporting System (PQRS) group practice reporting option (GPRO) (including Accountable Care Organizations [ACOs]) who have been assessed the 2016 payment adjustment  for failure to satisfactorily report PQRS in 2014.

Providers who believe they have been incorrectly assessed will have until November 9, 2015 to submit a request for CMS to investigate incentive eligibility and/or payment adjustment determination. Providers will be contacted via email of a final decision by CMS within 90 days their request. CMS states that all decisions will be final and there will be no process for further review or appeal.

For more information, please see the official CMS announcement.

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