The Physician Quality Reporting System (PQRS), is a provider-based program for reporting data on the quality of care to Medicare. The program is voluntary, but Eligible Professionals (EPs) who do not participate, or who do not adequately report quality measures, will be subject to negative payment adjustments in future years. A brief introductory video to PQRSopens in new window is available on online.
Successful reporting necessitates that EPs report on nine PQRS measures across three domains for 50 percent of their Medicare patients. EPs with fewer than nine measures applicable to their practice can demonstrate this through the Measure Applicability Validation (MAV) process.
On Sept. 26, CMS released the PQRS feedback reports for 2015. The feedback reports are available to every EP or qualifying group practice that submitted claims for services provided to beneficiaries in the traditional fee-for-service Medicare program. Instructions for accessing your 2015 PQRS feedback report are available on the CMS websiteopens in new window (PDF, 2.1MB). CMS also offers a User Guideopens in new window (PDF, 1.5MB) to the feedback report.
In addition to the release of the feedback reports, CMS announced that they are sending letters to EPs who did not successfully report PQRS quality measures in 2015 that they will have their payments reduced by 2 percent in 2017.
If you are an EP who receives a negative payment adjustment letter, you have the option to appeal. The period for requesting an informal review ends on Nov. 30, 2016.
To make this request, first obtain a copy of your 2015 PQRS feedback report. (EPs who reported PQRS measures through the APA Practice Organization’s PQRSPRO should contact Healthmonix to verify the data that was submitted.) Next, file a request for an informal review on the Quality Reporting Communication Supportopens in new window webpage. CMS will review the request and is expected to issue a decision within 90 days after the request is received.
Although CMS has taken steps to address the problems that arose with the MAV process last year, they are urging all psychologists who receive a negative adjustment letter to request an informal review.