Header graphic for print
Iowa Healthcare Law Blog News & Updates on Legal, Policy, & Business Issues Facing the Health Care Industry in Iowa

Time Remains to File a request for Informal Review of CY 2017 PQRS Negative Payment Adjustment

Posted in Centers for Medicare and Medicaid Services-CMS

QRUR Informal Review Also Available.

Physicians and other eligible professionals and practices who failed to meet criteria for satisfactory PQRS reporting in calendar year (CY) 2015 now face a negative 2% adjustment in Medicare Part B payments for CY 2017. Physicians who believe CMS has inappropriately determined that a negative PQRS payment adjustment applies to them have until November 30* to request an informal review.  CMS set forth the following instructions for requesting an informal review.  *Deadline for requesting informal review of VM calculations now extended to December 7, 2016.

  1. Go to the Quality Reporting Communication Support Page (CSP) [Note: this page will not under maintenance and not available November 18-20.]
  2. In the upper left-hand corner of the page, under “Related Links,” select “Communication Support Page”
  3. Select “Informal Review Request”
  4. Select “PQRS Informal Review”
  5. A new page will open
  6. Enter Billing/Primary Taxpayer Identification Number (TIN), Individual Rendering National Provider Identifier (NPI), OR Practice Site ID # and select “submit”
  7. Complete the mandatory fields in the online form, including the appropriate justification for the request to be deemed valid. Failure to complete the form in full will result in the inability to have the informal review request analyzed. CMS or the QualityNet Help Desk may contact the requestor for additional information if necessary.
CMS will inform persons requesting further review of its review determination by email within 90 days of the request. CMS review decisions are final.

Further information is provided in CMS’ PQRS informal review fact sheet. Persons with questions may contact CMS’ QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. CMS advises: to avoid security violations, do not include personal identifying information, such as Social Security Number or TIN, in e-mail inquiries to the QualityNet Help Desk.

CMS also has reminded physician groups and solo practitioners that the CY 2015 QRURs (Quality and Resource Use Reports), showing performance in that year to determine receipt of a Value Modifier (VM) payment adjustment in CY 2017, were released on September 26, 2016. Physicians also have the opportunity to seek CMS informal review of their QRUR findings through November 30, 2016. The process for doing so is available on CMS’ 2015 QRUR and 2017 Value Modifier webpage. Help Desk Information is the same as listed above.

*This Post revised on Dec. 1. 2016 as to extended deadline for requesting informal review of VM calculations.