Monday, Nov. 23, is the deadline for eligible providers, comprehensive primary care practice sites and groups participating in the Physician Quality Reporting System (PQRS) that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment to submit an informal review request. The Centers for Medicare and Medicaid Services (CMS) will investigate incentive eligibility and/or make a payment adjustment determination. 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.
In 2016, CMS will apply a negative payment adjustment to those individual providers and groups that did not satisfactorily report PQRS in 2014. Individuals and groups that receive the 2016 negative payment adjustment will not receive a 2014 PQRS incentive payment.
All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) by midnight on Monday. Please see 2014 PQRS: Incentive Eligibility & 2016 Negative Payment Adjustment – Informal Review Made Simple (available on the Analysis and Payment section of the PQRS website) 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 [email protected] 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.