PQRS: CMS Extends Informal Review Deadline to Dec. 7

If you submitted data to Medicare's Physician Quality Reporting System (PQRS) for the 2015 program year, make sure you review your quality reports. The reports include information about your quality and cost performance and whether you'll get hit with penalties or receive bonus payments. The Centers for Medicare and Medicaid Services extended the deadline to appeal errors in your report to 10:59 pm CT, Wednesday, Dec. 7, 2016. The original deadline was Nov. 30.

Quality Reports

On Sept. 26, Medicare announced the release of two quality reports. The first report is the 2015 PQRS feedback report, which contains information about your quality performance and whether you will receive a payment cut in 2016. If you receive the penalty, you will get a 2-percent pay cut on a per-claim basis under the 2017 Medicare Physician Fee Schedule (PFS). 

The second report is the annual Quality and Resource Use Report (QRUR), a component of Medicare's Value-Based Payment Modifier program. The QRUR provides detailed information about your quality and cost performance and how you compare with your peers. Under this program, Medicare used data on quality measures submitted to PQRS for the 2015 program year and data on cost measures and claims-based quality measures obtained from 2015 claims data to calculate the 2017 value modifier for all solo physicians and group practices. The value modifier is determined using a quality-tiering approach, and the annual QRUR indicates your quality tier designation: high, average, or low quality and cost. Depending on the designation, your payments will be adjusted up or down on a per-claim basis under the 2017 Medicare PFS. 

Please note that reviewing your PQRS feedback report and QRUR is part of the TMA Five-Step Checklist for MACRA Readiness. Analyzing your quality reports now will help you prepare for MACRA's new Merit-Based Incentive Payment System (MIPS). Additionally, TMA reminds physicians that Medicare had data issues and calculation errors in its quality reports last year, resulting in revised reports and mass confusion. For this reason, it is important that you review your reports as soon as possible to make sure your data are correct and you don't receive a penalty in error. 

Appeals Process 

If you disagree with Medicare's analysis of your performance or believe your data are incorrect, submit what is called an "informal review request" by Dec. 7, 2016. This is the only appeals process Medicare has for the PQRS and value modifier programs. Once a request has been submitted, Medicare will review your data again and respond to you through email within 90 days of your submission.  

Where to Turn For Help

TMA Practice Consulting offers quality improvement services to help prepare physician practices for the upcoming transition under the Medicare Access and CHIP Reauthorization Act (MACRA). TMA's practice management consultants can conduct a MACRA readiness assessment of your practice and provide customized on-site assistance to help you with your practice's specific needs. The assessment will focus on clinical processes, electronic health record optimization, and workflow improvement opportunities to help increase your MIPS scoring. TMA is dedicated to working with you and your practice to earn an incentive payment, not just avoid the penalty. To learn more, email practice.consulting[at]texmed[dot]org, or call (800) 523-8776.

You also can turn to the TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO) for help. Under contract with Medicare, the TMF QIN-QIO provides education and technical assistance to solo physicians, group practices, and other health care professionals for Medicare's quality programs. For help with your quality reports or the informal review request process, contact Suzie Buhr at TMF QIN-QIO at (214) 477-1407 or by email. To learn more, join the TMF Value-Based Improvement and Outcomes Network

Visit TMA's PQRS and VM Resource Center for guidance on quality reporting for the 2016 program year and the MACRA Resource Center to learn about how these programs will be combined to create the new MIPS program.  

Action, Dec. 1, 2016 

Last Updated On

December 01, 2016