Federal CMS releases 2014 PQRS and QRUR reports; informal review period opens

Tuesday, September 22, 2015 09:40 AM

On Sept. 9, the Centers for Medicare and Medicaid Services released the 2014 Quality and Resource Use Reports (QRURs) and 2014 Physician Quality Reporting System (PQRS) Feedback Reports. The 2016 PQRS and Value Modifier (VM) payment adjustments are based on 2014 reporting. For groups with 10 or more PQRS-eligible professionals (EPs) that are subject to the 2016 Value Modifier, the QRUR shows how the VM will affect Medicare’s 2016 payments to physicians. VM cost and quality scores will also be provided in the QRURs for other practices even though they are not yet subject to the VM. If physicians or group practices feel an incentive payment or penalty was performed in error they must file an Informal Review by Nov. 9, 2015. 

2014 EHR and QCDR data issues

As reported in the Sept. 3, 2015 Advocacy Update Issue, the federal CMS discovered various errors with the 2014 Physician Quality Reporting System (PQRS) data submitted by vendors on behalf of EPs and group practices that reported via electronic health records (EHR) and qualified clinical data registries (QCDR). The agency has stated there will be no need for physicians or group practices to submit a PQRS Informal Review request.

Because of the errors, the EHR and some of the QCDR data is inconsistent. Due to these errors, the agency will not post PQRS performance data for the affected practices on Physician Compare. However, determination of PQRS and Meaningful Use payment will not be affected because they are based solely on whether the practice successfully reported rather than on their actual performance—simply receiving the data will allow the federal CMS to deem a physician or group practice as successful for purposes of avoiding a payment adjustment in 2016 or for receiving a 2014 incentive.

For the value modifier, which involves calculating actual quality scores in addition to determining whether quality measures were reported, the agency has acknowledged the vendor data errors may create problems. Specifically, they will not be able to accurately calculate the PQRS portion of the Quality Composite Score. Instead, the quality score will be based solely on the claims-based outcomes measures and the Consumer Assessment of Healthcare Providers and Systems Survey, if applicable. 

2014 PQRS data submission problems

The American Medical Association is aware of instances in 2014 where physicians and practices mistakenly registered for the PQRS group practice reporting option (GPRO) submission mechanism and/or at the last minute their EHR vendor would not support their preferred submission mechanism. These groups or individuals will have to file an Informal Review by Nov. 9. The AMA believes this only affects a very small percentage of EPs and practices.

How to access the reports and file an informal review

To access the portal to review reports and/or file an Informal Review, an EIDM account is required. The federal CMS transitioned the portal from the Individual Access to CMS Computer Services (IACS) to the Enterprise Identity Management System (EIDM) on July 13. The IACS system is now retired, but current PQRS and VM IACS users, their data, and roles have moved to EIDM, which is accessible from the portion of the federal CMS Enterprise Portal at http://portal.cms.gov. The EIDM system provides a way for business partners to apply for, obtain approval for, and receive a single user ID for accessing multiple CMS applications.

For more information on 2014 feedback reports and how to request them, see “How to Obtain a QRUR.”