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  • The 2016 CMS Payment Penalties Related to PQRS: What You Need to Know

    Physical therapists (PTs) in private practice and other providers who participate in the physician quality reporting system (PQRS) are being sent notices from the Centers for Medicare and Medicaid Services (CMS) about a potential 2016 "negative payment adjustment," depending on whether they met satisfactory reporting requirements in 2014. Here's what you need to know:

    Who could be affected
    The notices affect individual eligible professionals (EPs) and group practices that registered for the 2014 group practice reporting option and billed under the Medicare physician fee schedule for Part B beneficiaries.

    What it's about
    CMS is following up on a rule that triggers payment adjustments for the affected providers who did not meet satisfactory reporting requirements in 2014. PTs who did not meet the satisfactory reporting requirements for the 2014 reporting year will be subject to a 2.0% penalty in 2016.

    How to find out if you're affected
    You can access your PQRS report online to find out if you're on the list of providers receiving a payment adjustment.

    What you can do about it
    If you think that an error was made and you shouldn't be receiving an adjustment, you can request an informal review. But do it soon—CMS says that the review window will only be open for 60 days after notices were sent, and most went out on September 11. Keep in mind that CMS is not issuing hardship exemptions—changes will be made only if CMS has made an error.

    CMS issued a fact sheet (.pdf) on the PQRS adjustments that offers details on the notice and additional links to other services and portals, including one that can inform you of all payment adjustments that you may be subject to in 2016, based on your tax identification number. Providers with questions should contact the CMS QualityNet Help Desk at 866/288-8912 (TTY 877/715-6222) or via qnetsupport@hcqis.org, 7:00 am-7:00 pm Central Time Monday through Friday.


    • The link to "access your PQRS report online" only returns "Failure of Server Apache Bridge".

      Posted by Tim on 9/18/2015 6:31 PM

    • Tim, it seems to be working on this end, both via Explorer and Firefox. Have you tried another browser?

      Posted by Troy Elliott -> BKW_=N on 9/21/2015 7:11 AM

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