PQRS 2016 Informal Review Process Request Period Open

Physician anesthesiologists and other providers who submitted Physician Quality Reporting System (PQRS) measures in 2014 and who will receive a negative adjustment for calendar year 2016 have an opportunity to ask the Centers for Medicare and Medicaid Services (CMS) for an informal review.

In 2016, CMS will apply a negative payment adjustment to individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites and group practices participating in the PQRS group practice reporting option (GPRO) that did not satisfactorily report PQRS in 2014. From September 9, 2015 through November 9, 2015, those who believe they have received an incorrect assessment may request an informal review from CMS. Requests should specify whether CMS should investigate the claims’ incentive eligibility and/or payment adjustment determination. CMS has stated that all requestors will receive an email with a final decision within 90 days of the original request for informal review. These decisions will be final.

Most physician anesthesiologists reported PQRS measures as individual EPs using the claims-based mechanism.  Those receiving this negative payment adjustment did not receive a 2014 PQRS incentive payment.

You must submit your request electronically via the CMS QualityNet webpage.  If you have any questions about this process, you may also contact the QualityNet Help Desk at [email protected] or 866-288-8912.

For basic information on PQRS, including rules and regulations for PQRS, reporting mechanisms and criteria, please visit the ASA website.

For additional information, please contact the ASA Department of Quality and Regulatory Affairs (QRA) at [email protected] or 202-289-2222.