If you’ve received a letter from CMS, find out how to appeal and avoid future penalties.

Update: The deadline to request an informal review is now 11:59 p.m. ET, Dec. 16, 2015.

On Sept. 11, the Centers for Medicare and Medicaid Services (CMS) began sending letters to eligible Medicare providers including psychologists who did not satisfactorily report Physician Quality Reporting System (PQRS) quality measures in 2014. The letter informs them that all of their 2016 Medicare Part B payments will be subject to a 2 percent reduction.

Psychologists who believe they did participate in PQRS and meet the 2014 requirements may request an informal review from CMS. The deadline to request a review of the payment adjustment determination is Nov. 9, 2015. CMS will notify all requesters of the outcome of the informal review via email within 90 days. All decisions are final.

All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which will be available Sept. 9, 2015, through Nov. 9, 2015, at 11:59 p.m. ET. 

There is still time for Medicare providers to report quality measures for 2015. Successful reporting for 2015 will protect Medicare providers from experiencing a 2 percent reimbursement penalty in 2017. PQRS reporting can be done via an electronic health record (EHR) system, by reporting measures on CMS claims forms or through a PQRS registry, such as the PQRSPRO registry available from the APA Practice Organization.

The Practice Organization, in collaboration with a leading health care data and technology company named Healthmonix, launched the PQRSPRO registry to focus on PQRS measures used by mental and behavioral health providers. PQRS participants have higher rates of success when reporting through registries and EHRs, rather than claims forms. The PQRSPRO system automatically calculates and validates your data to ensure successful submission.

Information about how to use the APA Practice Organization PQRSPRO registry is available on the registry website, which includes tutorials to guide participants through the reporting process. Registry staff members are available to provide support to participants.

If you have additional questions regarding the informal CMS review process, contact the QualityNet Help Desk at (866) 288-8912 (TTY 877-715-6222) or email Monday-Friday from 7 a.m. to 7 p.m. CT. To avoid security violations, do not include personal identifying information, such as social security number or taxpayer identification number , in email inquiries to the QualityNet Help Desk.

Date created: 2015