CMS Releases Quality and Resource Use Reports and 2018 Payment Adjustment Notifications

This week, the Centers for Medicare & Medicaid Services (CMS) released Quality and Resource Use Reports (QRUR) for physician anesthesiologists and other eligible professionals (EPs) that reported Physician Quality Reporting System (PQRS) measures in 2016. The reports detail individual or group performance on quality and cost measures in 2016 and indicate an associated payment adjustment, known as the Value-Based Payment Modifier (VM), to be applied to 2018 Medicare Part B Fee-For-Service payments.

QRURs are available for download via the Enterprise Identity Management System (EIDM). Learn more about accessing your QRURs.

Physician anesthesiologists and other EPs who did not meet PQRS reporting criteria will also receive a letter from CMS indicating a 2 percent downward payment adjustment. This payment penalty will be applied to 2018 payments either at the individual level via NPI/TIN combination or at the group or TIN level, depending on the reporting option of the EP or practice. In such cases, EPs and groups may request an informal review regarding potential errors to their 2018 Value Modifier calculation.

The informal review period is open until Friday, December 1. Learn more about requesting an informal review.

CMS is hosting a webinar on 2016 PQRS Feedback Reports and the Informal Review Process on Tuesday, September 26 from 1:30-3pm ET. Physicians, other EPs and practice administrators are encouraged to attend and must register for the webinar.

Please note that in the 2018 Proposed Medicare Physician Fee Schedule, CMS proposed to lessen the criteria for PQRS 2016 reporting year and to reduce penalties under the VM. These policy proposals have not been finalized and do not impact the QRURs at this time. Practices who do not agree with their QRUR assessments should request an informal review.

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