Physicians have until Feb. 28 to review 2013 PQRS payments and penalties

February 19, 2015
Area(s) of Interest: Payor Issues and Reimbursement Practice Management 

The Centers for Medicare and Medicaid Services (CMS) announced last week that physicians who believe they received an incorrect Physician Quality Reporting System (PQRS) payment penalty can now use the new Look Up tool to verify information without calling the CMS Help Desk.

The PQRS Look Up tool uses the same information that the CMS Help Desk accesses to verify whether a physician is subject to the 2015 PQRS payment adjustment, or if he or she should have received a 2013 PQRS incentive. To utilize the tool, physicians need to type in their Tax Identification Number (TIN) or TIN/ National Provider Identifier (NPI) combination.

If you feel you have received a PQRS payment adjustment in error, you should file an informal appeal by February 28. Providers, designated support staff/vendors and group practices who submit data for the PQRS program can request to have an informal review of their PQRS reporting performance through the Communication Support Page.

An informal review may be requested for any of the following reasons:

  • A practice's PQRS feedback report indicates that the practice did not earn the PQRS incentive payment when  staff believe they should have;

  • A practice believes the PQRS payment amount was incorrect; or

  • A practice received a notification in error from CMS indicating the provider did not successfully participate in 2013 PQRS and will receive a 2015 PQRS payment adjustment.

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