Do You Have a Medicare Bonus – or Penalty – Coming Next Year?

Well, the moment you've been waiting for has finally arrived.

No, you didn't win the lottery.

But if you participated in the 2016 Physician Quality Reporting System (PQRS) or the Value-Based Payment Modifier programs, you can now find out whether you'll receive bonus payments in 2018. Heyo! (You also can find out if you'll get hit with a payment cut, which is actually nothing like winning the lottery.)

Anyway, the Centers for Medicare & Medicaid Services (CMS) recently released two separate reports from the 2016 PQRS and Value Modifier programs that include information about your (yes, your) quality and cost performance. Both reports are accessible online only.

Under the PQRS program, CMS will soon send letters to physicians who will receive a 2-percent per-claim cut (say that five times quickly) to Medicare payments. 

Under the Value Modifier program – which uses a quality-tiering approach – the annual Quality and Resource Use Report (QRUR) will let you know your quality-tier designation: high, average, or low quality and cost. That means your Medicare payments will be adjusted up (bonus!) or down (penalty) on a per-claim basis as well.

You're going to want to read these reports as soon as possible to ensure that your data are correct and that you won’t receive a cut by mistake. 

Now, let's say you believe your data are incorrect; here's what you do: Submit an "informal review request" by Dec. 1. But. This is the only appeals process CMS has for these programs. 

  • To submit an informal review request for a PQRS feedback report, refer to the PQRS Informal Review Made Simple guide. 
  • To submit an informal review request for a QRUR, refer to the “Value Modifier Informal Review Request Quick Reference Guides” and FAQs on the Value Modifier website

In case you forgot, PQRS and Value Modifier payment adjustments, which are based on 2016 quality and cost performance, end in 2018. Both programs, along with the meaningful use program, were consolidated into the Merit-Based Incentive Payment System (MIPS) this year under the new Quality Payment Program. Medicare payment adjustments in 2019 will be based on your 2017 MIPS performance. Analyzing the data in your reports now will help you evaluate your performance on quality and cost measures so you can identify areas for improvement and take action to improve your overall score under the new MIPS program. 

For questions about your PQRS feedback report, contact the CMS QualityNet help desk. For questions about your QRUR, contact the CMS Physician Value help desk. For free help interpreting or accessing your report, contact the TMF Health Quality Institute or submit a help request online.

And for more information on all of these programs, you can always check out the Practice Help section of the TMA website.

Action, Oct. 2, 2017

Last Updated On

November 21, 2017

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