PQRS Payment Reduction Notice

CMS has sent letters regarding the 2017 Physician Quality Reporting System (PQRS) negative payment adjustment. The letter indicates that the recipient did not satisfactorily report 2015 PQRS quality measures or satisfactorily participate in a qualified clinical data registry and, therefore, all of their 2017 Medicare Part B Physician Fee Schedule payments will be subject to a 2.0% reduction.  The reduction applies only to payments to the entity associated with the Tax Identification Number (TIN)/National Provider Identifier combination noted within the letter.

If you believe that the 2017 PQRS negative payment adjustment is being applied in error, you can submit an informal review request.  The informal review period opened on September 26 and closes on November 30, 2016. CMS will investigate the merits of your request and issue a decision within 90 days. All requests must be submitted via a web-based tool on the Quality Reporting Communication Support Page.  Clinicians are encouraged to access and review their PQRS feedback reports and 2015 Annual Quality and Resource Use Reports (QRURs) prior to submitting an informal review request. The 2015 Annual QRUR provides information about your TIN’s 2017 Value Modifier payment adjustment for physicians.  Click here for more information about these reports.

The new Quality Payment Program will replace PQRS and the Value Modifier program, as well as the separate payment adjustments under the Medicare Electronic Health Record Incentive Program, with a streamlined program that has reduced quality reporting requirements and a flexible design that allows eligible clinicians to pick their pace of participation in the first year. To learn more about the new Quality Payment Program, please visit go.cms.gov/QPP.  The best way to prepare for success in the upcoming Quality Payment Program is to review your PQRS feedback report and QRUR, and consider your options for joining a Qualified Clinical Data Registry.

The 2016 PQRS program began January 1, 2016.  Reporting during 2016 impacts your 2018 PQRS payment adjustment. Please visit the PQRS webpage for complete information on how to participate in 2016 to avoid the 2018 payment reduction.

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