What Is an Informal Review?

An informal review is an appeals-like process that allows physicians and groups to request a review of their incentive eligibility or payment adjustment determination. For example, if you disagree with Medicare’s analysis of your quality and cost performance or believe your final determination on your quality report is incorrect, CMS will allow you to submit what is called an “informal review request” during the annual 60-day informal review period. 

This period starts the day the quality reports are made available by CMS. Please note that this is the only appeals process Medicare has for PQRS and the VM program. If you miss the deadline to file an informal review, any payment penalty you are subject to will stand for an entire calendar year. If you do submit an informal review request, Medicare will review your data again and respond to you through email within 90 days of your submission. For this reason, it is very important that you access and review your quality reports.

TMA anticipates the release of the annual quality reports in September 2017, so make sure you access your quality reports on a timely basis. Monitor CMS information about the informal review period and, visit TMA’s Deadlines for Doctors. If you need to file an informal review request during the 60-day window, visit the PQRS Informal Review Request website to submit a request for a PQRS feedback report, and visit the VM Informal Review Request website to submit a request for a QRUR.

Learn more about the informal review process in the March 2016 issue of Texas Medicine.

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Last Updated On

May 13, 2016

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