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  • CMS Sets Dec 1 Deadline for PQRS Appeals

    Did you participate in the Physician Quality Reporting System (PQRS) in 2016? You can check on your 2016 reporting results and find out if you're subject to any payment adjustments for 2018. But take note: if you’ve received a payment reduction notice and think the decision was made in error, you need to submit a request for review by December 1.

    The Centers for Medicare and Medicaid Services (CMS) released the reporting results—known as the Annual Quality and Resource Use Reports (QRURs)—as well as the feedback reports for online viewing on September 18. The 2016 PQRS feedback report contains all detailed information used to determine your 2016 reporting results and indicates if you are subject to the 2018 PQRS negative payment adjustment.

    More recently, CMS sent out individual notices to providers it believes did not meet PQRS requirements in 2016. Those providers are subject to Medicare Part B payment reductions beginning in 2018.

    If you have been identified for a 2018 payment reduction based on the report, and you think that decision was made in error, you'll need to ask for an informal review. CMS offers instructions on that process on the PQRS Analysis and Payment webpage. To make your appeal as effective as possible, be sure to thoroughly review your QRUR and provide detailed reasons why you think the reduction decision was a mistake—and don’t forget the December 1 deadline. APTA staff are available to answer emailed questions about the process at advocacy@apta.org.

    You can access the QRUR reports through the CMS "enterprise portal," but to do that you'll need an enterprise identity management (EIDM) account (CMS provides instructions for creating an EIDM). Also available: a user guide to the reports.

    For additional assistance regarding EIDM or the data contained in the PQRS feedback reports, contact the QualityNet Help Desk at 866/288-8912 (TTY 877/715- 6222) 7:00 am–7:00 pm CT, Monday through Friday, or by email at qnetsupport@hcqis.org. If you are having trouble accessing the PQRS feedback reports, contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 888/734-6433.

    PQRS ended in 2016 and became part of the Merit-based Incentive Payment System (MIPS). For more information on the transition, check out PT in Motion magazine’s 2-part series on MIPS in the 2017 April and May issues.