December 1, 2016

In 2017, the Centers for Medicare and Medicaid Services (CMS) will apply a downward payment adjustment to those who did not satisfactorily report PQRS in 2015 including:

  • Individual eligible professionals (EPs)
  • Comprehensive Primary Care (CPC) practice sites
  • PQRS group practices
  • Accountable Care Organization (ACO) participant TINs

If you have any questions regarding the status of your 2015 PQRS reporting or are concerned about potentially receiving the PQRS downward payment adjustment in 2017, please do not hesitate to submit an informal review request. CMS will be in contact with every individual EP or PQRS group practice that submits a request for an informal review of their 2015 PQRS data.

If you believe you have been incorrectly assessed the 2017 PQRS payment adjustment, submit an informal review between Sept. 26, 2016 and Nov. 30, 2016 requesting CMS investigate your payment adjustment determination. All informal review requestors will be notified via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review. 

Follow these steps to submit an informal review request:

  1. Go to the Quality Reporting Communication Support Page (CSP)  
  2. In the upper left-hand corner of the page, under “Related Links,” select “Communication Support Page”
  3. Select “Informal Review Request”
  4. Select “PQRS Informal Review”
  5. A new page will open
  6. Enter Billing/Primary Taxpayer Identification Number (TIN), Individual Rendering National Provider Identifier (NPI), OR Practice Site ID # and select “submit”

Complete the mandatory fields in the online form, including the appropriate justification for the request to be deemed valid. Failure to complete the form in full will result in the inability to have the informal review request analyzed. CMS or the QualityNet Help Desk may contact the requestor for additional information if necessary.

Please see the PQRS informal review fact sheet for more information. 

Note: Any EP or group that is awaiting a response or resolution of a QualityNet Help Desk ticket to access their PQRS Feedback Report or QRUR may still submit an informal review after November 30, 2016, by providing verification of a QualityNet Help Desk ticket numbers generated before the end of the informal review period (November 30, 2016 ) that involve EIDM access. Individuals or groups (as identified by their taxpayer Identification Number (TIN) may also use EIDM-related help desk tickets generated during the informal review period to enable late filing of a Value Modifier or PQRS informal review request. These late requests may be submitted through December 7, 2016.

Additionally, 2015 PQRS feedback reports can be accessed on the CMS Enterprise Portal using an Enterprise Identity Management (EIDM) account. For details on how to obtain your report, please see the “Quick Reference Guide for Accessing 2015 PQRS Feedback Reports”. For information on understanding your report, please see the “2015 PQRS Feedback Report User Guide”. Both guides are on the PQRS Analysis and Payment webpage.

For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. To avoid security violations, do not include personal identifying information, such as Social Security Number or TIN, in e-mail inquiries to the QualityNet Help Desk.
 

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