Nov. 30 deadline for seeking review of potential payment penalties

Wednesday, October 19, 2016 12:26 PM

Late last month, the Centers for Medicare and Medicaid Services posted information on its website that physicians can consult to determine whether they will be subject to 2017 payment penalties associated with the Physician Quality Reporting System (PQRS) and the Value Modifier. As reported in the most recent Advocacy Update, practices that have concerns about the findings in their report(s) have until Nov. 30 to file for an informal review of their data.

Find instructions on requesting an informal review here in the PQRS “Informal Review Made Simple” document; the steps are outlined on pages 4-5.

The penalties in question stem from policies in effect prior to the enactment of the Medicare Access and CHIP Reauthorization Act. Failure to successfully complete required PQRS reporting will result in a 2 percent penalty. Value Modifier penalties can range from 1 percent to 4 percent depending on the size of the practice and its performance on cost and quality measures. PQRS penalties will be communicated to physicians by mail as well as in the PQRS feedback reports posted on the CMS website. Value Modifier penalties and bonuses can be found in Quality and Resource Use Reports (QRURs) posted on the website only.

Additional information on accessing the reports and filing for an informal review can be found here and here. Those who have questions, even if they are uncertain about penalty status, are urged to submit a request for informal review. Although in most cases a successful PQRS review will trigger an automatic review of related VM penalties, program officials say the safest course is to file requests for review of both PQRS and VM data.