Deadline is Rapidly Approaching for Therapy Providers To Request Informal Review of PQRS Payment Adjustment

19 Nov 2015

NOTE: The post below has been updated to reflect CMS’s extension of the informal review request deadline through December 11th, 2015 which was announced the day after the original blog entry was posted.

CMS has sent letters to providers who are subject to the negative PQRS payment adjustment in 2016. Eligible professionals who believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment may submit an informal review request through December 11, 2015 requesting that CMS investigate the payment adjustment determination.  All informal review requestors will be contacted via email of a final decision by CMS within 90 days of the original request for an informal review.  To submit the request, providers should visit the Quality Reporting Communication Support Page (www.qualitynet.org/portal/server.pt/community/informal_review_request/).  This page will be available through December 11, 2015, so providers should act quickly.

To review, therapy providers who did not satisfactorily report data on PQRS quality measures between January 1 and December 31, 2014, will be subject to a 2.0% reduction in their fee schedule amount in 2016. In order to satisfactorily participate in PQRS for the 2014 reporting year, therapy providers needed to report a minimum of 3 individual measures for 50% of all eligible Medicare patients via claims or registry within the 12-month reporting period.  The 2016 negative payment adjustment applies to individual providers based on the Tax Identification Number (TIN) and National Provider Identification (NPI) under which they reported in 2014. Therapists who are subject to the negative payment adjustment will receive 98% of their allowed Medicare Part B payments for services provided between January 1 and December 31, 2016. (The payment adjustment affects the reimbursement to the provider only and does not affect the beneficiary’s copay amount.)

For more information on the informal review process or PQRS feedback reports, visit the QualityNet home page: https://www.qualitynet.org/portal/server.pt/community/pqri_home/212.


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