In upcoming weeks, the Centers for Medicare & Medicaid Services (CMS) will send letters to provider and group practices subject to the payment adjustments for the 2015 PQRS Program. PQRS eligible professionals (EPs) and group practices have 60 days after the letter is issued to file an Informal Review with CMS to contest a penalty.
Who’s receiving this letter and why?
Consistent with current regulations, CMS will apply a negative 2% payment adjustment to 2017 payments under the Medicare Physician Fee Schedule (MPFS) to individual EPs and PQRS group practices who did not satisfactorily report PQRS data in 2015. If you think CMS has applied an adjustment incorrectly, you should follow the directions at the bottom of this article on how to file an informal review request.
Accessing your data to measure quality and resource use (Cost)
It is critically important to review your PQRS Program Feedback Data and be informed on your performance for 2015 and to guide your reporting under the MIPS Quality category in 2016 and beyond.
In addition, clients should access and review Annual QRUR, which provide feedback on value-based modifier (VBM) data. This data indicates how providers are likely to perform in the MIPS Resource Use (Cost) category.
CMS will post 2015 PQRS Program Feedback and Annual Quality Resource and Usage Reports (QRUR) on the CMS Enterprise portal at the time penalty letters are sent. These reports are accessible to all EPs and group practices and contain performance information by TIN.
- PQRS 2015 Feedback reports inform EPs and group practices whether they met PQRS in 2015 and on what basis this determination was made. A report will be generated 1) if an EP or group practice submitted PQRS quality data through one of the approved reporting mechanisms or 2) an EP submitted MPFS claims that included denominator-eligible instances but did not submit PQRS data.
- 2015 Annual QRUR show for EPs and group practices the TIN’s performance on all quality and cost measures used to calculate the 2017 Value Modifier. A separate Value Modifier Informal Review (separate from the PQRS Program Informal Review) can be filed by the EP or group practice if the performance results are believed to be inaccurate.
Register for EIDM now to access feedback and QRUR reports:
CMS encourages all EPs and group practices to register for an account in the Enterprise Identity Management Information System (EIDM) to access the CMS Enterprise Portal to obtain 2015 Feedback and Annual QRUR. If you have an EIDM account, CMS advises you log in now to ensure that your account is active. EIDM is accessible from the CMS Enterprise Portal at https://portal.coms.gov/.
How to file an informal review
- A 2015 PQRS Informal Review is filed on the Quality Reporting Communication Support Page
- A 2015 Value Modifier Informal Review will be filed on a separate CMS website; the website and instructions pending CMS release soon.
Resources:
CMS Help Desks
PQRS Questions:
Quality Net Help Desk
866-288-8912 (TTY 877-715-6222)
Value Modifier questions:
Physician Value Help Desk
888-734-6433 Option 3
CMS websites
- Understanding 2017 Medicare Quality Program Payment Adjustments
- IACS – EIDM User Guide
- The EIDM System Toolkit
- How to Obtain a QRUR
- CMS Enterprise Portal to Access Reports
- Quality Reporting Communication Support Page – File PQRS Informal Review