Deadline approaching to request PQRS informal review!

October 20, 2017

Have you reviewed your 2016 Physician Quality Reporting System (PQRS) feedback report and Quality Resource Use Report (QRUR) yet? Keep in mind that you now have less than two months before the Dec. 1 deadline to submit a request for an informal review if you feel your group has been unfairly penalized.

Unlike the new Quality Payment Program, PQRS does not offer incentives to strong performers. Instead, groups and individuals who failed to report six quality measures across three National Quality Strategy domains (unless exempted by a MAV), will receive a negative 2 percent payment adjustment on Medicare claims paid under the MPFS in 2018. The reduction from nine to six measures was announced by CMS earlier this year as part of an attempt to bring the final year of PQRS in line with current Merit-based Incentive Payment System requirements.

Additionally, groups will also be hit with the Value Modifier penalty in 2018 if fewer than 50 percent of their PQRS participants failed their 2016 reporting. Groups of nine or fewer physicians will receive an additional 2 percent penalty, while groups of 10 or more would see a whopping 4 percent reduction on top of the PQRS penalty!

Both PQRS feedback reports and QRURs can be reviewed through the CMS Enterprise Portal using your Enterprise Identity Management account.

As with other CMS programs, mistakes are made! That’s why it’s important to submit a request for a review if you have any questions concerning CMS’s methodology for assessing a penalty. Vachette has assisted numerous clients with this process since PQRS was first implemented and will gladly offer our expertise to groups who may be facing a penalty for the first time.

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