11/30/2015

PQRS Negative Payment Adjustments Overturned

In response to the questions about PQRS denials, we have become aware members have received letters from CMS indicating that they would be receiving a 2-percent payment reduction in 2016 for failing to meet the requirements for PQRS reporting in 2014. Many of these members indicated that they utilized the claims method for reporting individual measures and they were certain they had met the requirements.

APMA has reached out to CMS regarding this issue on behalf of members to investigate the large number of failures, and CMS has indicated that it is looking into this situation. APMA would also like to gather data on the number of members receiving the payment reduction for 2016. Please complete this very brief survey so they may compile data for our continued discussion with CMS.

RECEIVED AN ADJUSTMENT LETTER?: If you were among the impacted providers, you would have received a payment adjustment letter even though CMS had already overturned your payment adjustment. To confirm, you can call the help desk (866-288-8912), or use the PQRS Look Up tool to see if you are still subject to the payment adjustment. If you use the Look Up tool, it will either say, “subject to the PQRS payment adjustment” or “was NOT subject to the PQRS payment adjustment.”

DEADLINE EXTENSION: CMS is extending the 2014 Informal Review period for PQRS negative payment adjustments. Eligible professionals that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment now have until 11:59 p.m. Eastern Time on December 11, 2015 to submit an informal review requesting CMS investigate incentive eligibility and/or payment adjustment determination.

This is an extension from the previous deadline of November 23, 2015. All informal review requestors will be contacted 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. All informal review requests must be submitted electronically via the www.qualitynet.org Quality Reporting Communication Support Page (CSP).