Two new reports are now available with information on 2015 cost and quality data that indicate which physicians or practices will see related Medicare payment adjustments in 2017.
The 2015 Physician Quality Reporting System (PQRS) Feedback Reports and 2015 Annual Quality and Resource Use Reports (QRUR) were released on Sept. 26. The Centers for Medicare & Medicaid Services (CMS) began mailing 2015 PQRS penalty letters to physicians on that date as well.
A penalty letter is your notification that you are scheduled to receive a two percent penalty in 2017 based on 2015 PQRS reporting. Letters are only issued to those who will receive negative payment adjustments, but if you do not receive a letter it is still a good idea to check your reports for any discrepancies. The PQRS feedback report allows you to look up whether you will receive a two percent 2017 PQRS penalty, and also contains detailed information on program year 2015 PQRS reporting results
The 2015 Annual QRURs provide information on your practice performed on quality and cost measures used in the Value Modifier (VM) and whether your VM payment adjustment will be positive, negative or neutral and also details the specific amount.
VM penalties can range from -1 to -4 depending on practice size and performance. Bonus payments depend on how much money is collected from penalties and to date the 2017 bonus size has not been publically announced. Drill-down tables in the reports contain detailed information on care delivered to individual patients by other providers as well as the physicians in the practice.
The payment adjustments detailed in these reports are associated with current performance-based Medicare payment incentives that will be replaced in 2019 with a new system created under the Medicare Access and CHIP Reauthorization Act (MACRA). If you believe there are errors in the report or calculation of the payment adjustment, you should file for an informal review prior to midnight Eastern Time on Nov. 30.
An Enterprise Identity Management (EIDM) account with the appropriate role is required to obtain 2015 PQRS feedback reports and 2015 Annual QRURs.
If you already have an EIDM account, visit the CMS website to sign up for the appropriate EIDM role or contact QualityNet Help Desk to determine if someone in your practice already has that role. To sign up for an EIDM account, visit the CMS Enterprise Portal and click “New User Registration” under “Login to CMS Secure Portal.” You can access both reports on the portal using the same EIDM account.
- For 2017 PQRS negative payment adjustment informal review, view the “2015 Physician Quality Reporting System (PQRS): 2017 Negative Payment Adjustment - Informal Review Made Simple” guide on the PQRS Analysis and Payment Web page.
- For informal review on 2015 QRURs or the 2017 Value Modifier calculation, see the 2015 QRUR and 2017 Value Modifier Web page.
The CMS Helpdesk is available to help you through these processes. For assistance regarding EIDM or the content or data contained in your PQRS Feedback Reports, contact the QualityNet Help Desk at (866) 288-8912 [TTY (877) 715- 6222)] from 7 a.m. to 7 p.m. Central Time, Monday through Friday, or via email.
For additional assistance regarding the QRUR or the Value Modifier, or if you are having trouble accessing the PQRS Feedback Reports, email the Physician Value Help Desk or call (888) 734-6433 (select option 3).