In 2017, CMS may apply a penalty to individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, and group practices who participated in the Physician Quality Reporting System (PQRS) group practice reporting option (GPRO) (including Accountable Care Organizations [ACOs]) that did not satisfactorily report PQRS in 2015. Individuals and groups that receive the 2017 penalty will not receive a 2015 PQRS incentive payment.
Individual EPs, designated support staff/vendors, and PQRS group practices that believe they have been incorrectly assessed the 2017 PQRS negative payment adjustment may request to have an informal review of their PQRS reporting performance.To request an informal review (when available), visit the Physician and Other Health Care Professionals Quality Reporting Portal then select “Communication Support Page” under “Related Links” in the upper left navigation pane. In the drop-down menu, select “Informal Review Request” and choose the appropriate option.
An informal review may be requested if the feedback report reveals that the individual EP or PQRS group practice disagrees with the analysis of satisfactory reporting to avoid a future payment adjustment. Informal review requests for 2015 reporting results may be submitted in the fall of 2016. Please note that the informal review decision will be final, and there will be no further review.
If you completed PQRS EHR reporting for the 2015 reporting year, you may gather resources from Practice Fusion to submit with your informal review. If you exported the PQRS attestation data from your PQRS Clinical Quality Measures Dashboard, you may locate the original file within the Documents tab of your Tasks section. The document can be found in either the Pending or Signed tabs.
The document title may begin with QRDA with the date it was initially exported. Click on the document title to review the file, then print or download the document to submit to CMS.
Please note that while Practice Fusion’s EHR contains a copy of the exported file, Practice Fusion cannot provide proof that the file was submitted for attestation during the review process.
Please review CMS's Payment Adjustment Information resource for more information.
For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. To avoid security violations, do not include personal identifying information, such as Social Security Number or Taxpayer Identification Number (TIN), in e-mail inquiries to the QualityNet Help Desk.