The Centers for Medicare and Medicaid Services (CMS) will soon begin distributing letters to Physician Quality Reporting System (PQRS) individual eligible professionals (EPs), EPs providing services at a Critical Access Hospital (CAH) billing under method II, and group practices regarding the 2017 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 (QCDR) in order to avoid the 2017 PQRS negative payment adjustment and, therefore, all of their 2017 Medicare Part B Physician Fee Schedule (PFS) payments will be subject to a 2.0% reduction.
The 2017 PQRS payment adjustment letter being sent to individual EPs includes a Tax Identification Number (TIN)/National Provider Identifier (NPI) combination; the adjustment applies only to the individual EP associated with the TIN/NPI noted within the letter and not the clinic or facility.
The 2017 PQRS payment adjustment letters being sent to PQRS group practices includes a TIN only and applies to all EPs who have reassigned their billing rights to the TIN. Please check your letter in the upper left hand corner to determine if it contains your TIN or TIN/NPI.
For the 2015 reporting period, the majority of eligible clinicians successfully reported to PQRS and avoided the negative payment adjustment. CMS expects that successful trend to continue, under the new Quality Payment Program. 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 to consider your options for joining a Qualified Clinical Data Registry.
If I received the payment adjustment letter, what are my options?
CMS would also like you to know that there are no hardship exemptions for the PQRS negative payment adjustment.
If you believe that the 2017 PQRS negative payment adjustment is being applied in error, you can submit an informal review request within 60 days of the September 26 release date of the 2015 PQRS feedback reports. Informal review will open on September 26 and close at on November 30, 2016 at 11:59 p.m. Eastern Standard Time. CMS will investigate the merits of your informal review request and issue a decision within 90 days of receipt. To request an informal review, 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. CMS will announce the availability of the 2015 PQRS feedback reports and 2015 Annual QRURs via the Medicare Learning Network (MLN) Connects Provider eNews, PQRS Listserv, and other CMS-related listservs.
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 negative payment adjustment.