Submit 2016 PQRS and VM Appeals by December 1, 2017

Physician anesthesiologists and their practices have until Friday, December 1st to file an informal review of their Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) statuses for 2018.

In September, the Centers for Medicare & Medicaid Services (CMS) released Quality and Resource Use Reports (QRUR) to physician anesthesiologists and other eligible professionals (EPs) that reported PQRS measures in 2016. The reports detail individual or group performance on quality and cost measures for that year and indicate an associated payment adjustment to be applied to 2018 Medicare Part B Fee-For-Service payments.

QRURs are available for download here, via the Enterprise Identity Management System (EIDM).

In addition to their QRUR, physician anesthesiologists and other EPs who did not meet PQRS reporting criteria will have received 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.

Practices who do not agree with their QRUR assessments or found potential errors in their assessments should request an informal review. The informal review period is open until Friday, December 1. Learn more about requesting an informal review.

Please note that in the 2018 Final Medicare Physician Fee Schedule, CMS lessened the criteria for PQRS 2016 reporting year and reduced penalties under the VM. For PQRS, if you satisfactorily reported at least six PQRS measures or passed the Measure-Applicability Validation (MAV) process, you will receive a 0 percent adjustment and move to VM quality-tiering. In that case, practices would be eligible for a 0, 1, or 2 percent upward VM adjustment based upon cost and quality scores.

For physician anesthesiologists who did not satisfactorily report PQRS measures, they will receive an automatic 2 percent downward PQRS adjustment. In addition, their practices will receive a -1 percent VM adjustment for practices of 1-9 eligible professionals or a 2 percent downward VM adjustment for practices of 10 or more EPs.

These policy changes, though finalized, will not be reflected on your QRUR until early next year.

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