October 06, 2017
Area(s) of Interest: Payor Contracting Payor Issues and Reimbursement
The Centers for Medicare and Medicaid Services (CMS) recently released data that indicates which physicians will be subject to the 2018 payment penalties associated with the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (Value Modifier) programs. Physicians who have concerns about the findings in their report(s) have until December 1, 2017, to file for an informal review of their data.
The penalties stem from policies in effect prior to the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA). Failure to successfully report on PQRS in 2016 will result in a 2 percent penalty in 2018. Value Modifier 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. Value Modifier penalties can be found in the Quality and Resource Use Reports (QRUR), which are only posted on the website.
Physicians may access both their 2016 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 2016 PQRS Feedback Reports.” For information on understanding your report, see the “2016 PQRS Feedback Report User Guide.” Both of the PQRS guides are available on the PQRS Analysis and Payment webpage.
For more information on understanding the reports, CMS is hosting a webcast on October 19 from 10:30 a.m. to 12 p.m. PT, which will provide a QRUR overview and explain how to interpret and use the report information. To register for this event click here, or contact email@example.com for registration assistance.
Physicians who wish to dispute their PQRS findings are urged to submit a request for informal review. While in most cases a successful PQRS review will trigger an automatic review of related Value Modifier penalties, program officials say the safest course is to file separate requests for review of both PQRS and Value Modifier data.
All informal review requests must be submitted electronically through the Quality Reporting Communication Support Page by December 1, 2017, at 5 p.m., PT.
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, as it will be communicated via email only. CMS also has published the “2018 Value Modifier Informal Review Request Quick Reference Guide.”
Physicians who have general questions about the report or have trouble accessing the reports online should contact the Physician Value Help Desk at (888) 734-6433 (select option 3) or firstname.lastname@example.org.
For additional questions, please contact the QualityNet Help Desk at (866) 288-8912 or via email@example.com between the hours of 5 a.m. and 5 p.m., PT, Monday through Friday.
For information regarding other Medicare physician quality programs that apply payment adjustments, please see the Value-Based Payment Modifier website.