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2017 PQRS Negative Payment Adjustment – 28 Days Remaining to Submit an Informal Review

Oct 26, 2016

In 2017, the Centers for Medicare & Medicaid Services (CMS) will apply a negative payment adjustment to individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, and group practices participating in the Physician Quality Reporting System (PQRS) group practice reporting option (GPRO), including Accountable Care Organizations (ACOs) that did not satisfactorily report PQRS in 2015.

EPs, CPC practice sites, PQRS group practices, and ACOs that believe they have been incorrectly assessed the 2017 PQRS negative payment adjustment may submit an informal review by November 30, 2016 requesting CMS investigate payment adjustment determination. All informal review requesters will be notified via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review. 

If you have any questions regarding the status of your 2015 PQRS reporting or are concerned about potentially receiving the PQRS negative payment adjustment in 2017, please do not hesitate to submit an informal review request. CMS will be in contact with every individual EP or PQRS group practice that submits a request for an informal review of their 2015 PQRS data.

Follow these steps to submit an informal review request:

  1. Go to the Quality Reporting Communication Support Page (CSP)  
  2. In the upper left-hand corner of the page, under “Related Links,” select “Communication Support Page”
  3. Select “Informal Review Request”
  4. Select “PQRS Informal Review”
  5. A new page will open
  6. Enter Billing/Primary Taxpayer Identification Number (TIN), Individual Rendering National Provider Identifier (NPI), OR Practice Site ID # and select “submit”
  7. Complete the mandatory fields in the online form, including the appropriate justification for the request to be deemed valid. Failure to complete the form in full will result in the inability to have the informal review request analyzed. CMS or the QualityNet Help Desk may contact the requester for additional information if necessary.

Please see “2015 PQRS: 2017 PQRS Negative Payment Adjustment - Informal Review Made Simple” available on the PQRS Analysis and Payment webpage for more information. 

NOTE: CSP will be unavailable during the following Maintenance Weekend: November 18-20.

Additionally, 2015 PQRS feedback reports can be accessed on the CMS Enterprise Portal using an Enterprise Identity Management (EIDM) account. For details on how to obtain your report, please see the “Quick Reference Guide for Accessing 2015 PQRS Feedback Reports”. For information on understanding your report, please see the “2015 PQRS Feedback Report User Guide”. Both guides are on the PQRS Analysis and Payment web page.

For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7 am-7 pm (CT). To avoid security violations, do not include personal identifying information, such as Social Security Number or TIN, in e-mail inquiries to the QualityNet Help Desk.