November 09, 2016
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
The Centers for Medicare and Medicaid Services (CMS) recently released data that indicates which physicians will be subject to the 2017 payment penalties associated with the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) programs. Physicians who have concerns about the findings in their report(s) have until November 30 to file for an informal review of their data.
The penalties in question stem from policies in effect prior to the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA). Failure to successfully complete required PQRS reporting in 2015 will result in a 2 percent penalty in 2017. VM penalties can range from 1 to 4 percent, depending on the size of the practice and its performance on cost and quality measures. PQRS penalties will be communicated to physicians by mail as well as in the PQRS feedback reports posted on the CMS website. VM penalties can be found in the Quality and Resource Use Reports (QRUR), which are only posted on the website.
Physicians may access both their 2015 PQRS feedback reports and QRURs on the CMS Enterprise Portal using an Enterprise Identity Management account. For details on how to obtain your QRUR report, see “How to obtain a QRUR” on the CMS.gov webpage. For information on obtaining your PQRS report, see the “Quick Reference Guide for Accessing 2015 PQRS Feedback Reports.” For information on understanding your report, see the “2015 PQRS Feedback Report User Guide.” Both of the PQRS guides are available on the PQRS Analysis and Payment webpage.
Those who have questions, even if they are uncertain about penalty status, are urged to submit a request for informal review. Although in most cases a successful PQRS review will trigger an automatic review of related VM penalties, program officials say the safest course is to file requests for review of both PQRS and VM data.
All informal review requests must be submitted electronically through the Quality Reporting Communication Support Page by November 30, 2016, at 11:59 p.m., ET. Physicians wishing to request an informal review of their QRUR and VM results should contact the Physician Value Help Desk at (888) 734-6433(select option 3) or email@example.com. CMS also has published the “2017 Value Modifier Informal Review Request Quick Reference Guide.”
Practices will be contacted by email with a final decision from CMS within 90 days of the original request for an informal review. All decisions will be final, with no opportunity for further review. Practices that do not receive a response are encouraged to check their junk or spam email folders for the decision.
For additional questions, please contact the QualityNet Help Desk at (866) 288-8912 or via firstname.lastname@example.org between the hours of 7 a.m. and 7 p.m., CT, Monday through Friday.
For information regarding other Medicare physician quality programs that apply payment adjustments, please see the Value-Based Payment Modifier website.
For step-by step instructions on how to implement PQRS, view the How to Get Started page. Additionally, the California Medical Association (CMA) updated its resource, “2016 PQRS and Value-Based Modifier Getting Started Guide,” which is available free to CMA members in the CMA Store.