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.

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

The Senate passed H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), on a vote of 92-8. Iowa’s Senators Joni Ernst and Charles Grassley voted in favor of the bill. The Senate considered amendments to the bill as passed by the House, but none were adopted. The H.R. 2 now goes to the President who has said he will sign the bill.

The bill immediately repeals the SGR and, of interest to Iowa physicians, extends the 1.0 Work GPCI floor through 2017. Physicians will receive an annual update of 0.5% for the next five (5) years, with the first update slated for July 1, 2015, and annual 0.5% updates effective on January 1 in each year 2016-2109. A fuller explanation of the bill is available from an earlier posting: click here to read.

CMS had placed a 10-day hold on submitted claims for services provided on April 1 and after which otherwise would have been paid at a rate reflecting the 21% SGR cut and loss of the 1.0 Work GPCI floor, both of which were effective as of April 1. Those claims, however, now can be paid at the same rate as in effect on March 31. Any claims that may have been paid at a rate reflecting the 21% SGR cut will be reprocessed by CMS and do not require further action by providers who submitted the claims.