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Practices and eligible professionals (EP) have until December 7, 2016 to submit an appeal if they received a payment adjustment under the Physician Quality Reporting System (PQRS) or if they dispute their Value-Based Payment Modifier (VM) findings.
CMS has indicated:
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 September 26, 2016 and December 7, 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”
For more information on PQRS and VM appeals process, please visit the ASA Quality Improvement website or contact Quality and Regulatory Affairs at [email protected].
