The PQRS Negative Payment Adjustment Notification Letters

September 29, 2016

Written by Sarah Leake

Soon, CMS will begin distributing letters to each Eligible Professional who did NOT satisfactorily report 2015 PQRS quality measures. The purpose of this letter is to inform each individual or group who will be receiving a 2.0% reduction on all their 2017 Medicare Part B Physician Fee Schedule payments. The good news is the majority of eligible professionals successfully reported PQRS in 2015 so fewer of you will be receiving this letter than last year! This letter pertains only to the PQRS program and, if you received this letter, you could also be subjected to additional negative adjustments under the Value Modifier program.

If you do receive one or more of these letters, here are the important things to know.

FIRST, determine who is affected by the payment reduction. Look at the number in the upper LH corner of letter. Is it just the Tax Identification Number (TIN) or does it also contain the TIN plus the National Provider Identifier (NPI) number for a TIN/NPI combination number?

• If a letter is sent to individual EPs, a TIN/NPI combination number will be listed and the adjustment applies only to the individual EP associated with the TIN/NPI noted within the letter and not the clinic or facility.
• If the letter is sent to PQRS group practices, a TIN only is listed and the adjustment applies to all EPs who have reassigned their billing rights to the TIN.

SECOND, understand your options.

• Submit an informal review if you believe the negative payment adjustment is being applied in error. This would be an appropriate step if you submit 2015 PQRS quality measures and are getting a negative payment adjustment. Review the PQRS feedbacks to learn more about why CMS is giving this adjustment.
• Deadline to submit the informal review is November 30.
• CMS will investigate and issue a decision within 90 days of receipt.
• Informal review requests are submitted via a web-based tool at:

Quality Reporting Communication Support Page

Please note – this link is for an Informal Review for PQRS only. To submit an Informal Review for the Value Modifier, please use the Informal Review option located in EIDM in the PV-PQRS section.

• If you did not submit 2015 PQRS quality measures, there are no hardship exemptions for the PQRS negative payment adjustment.

For further information regarding the 2017 PQRS negative payment adjustment, please see the PQRS Payment Adjustment Information webpage.

THIRD, prepare for 2016 PQRS quality measure submission.

• If you will be getting a negative payment adjustment in 2017, you will want to review your approach to reporting PQRS quality measures for 2016 to avoid negative payment adjustments in the future. Our staff is available to discuss your strategy and answer your questions.

Please see other blog posts about important information on the Value Modifier program and any adjustments which may occur under the Value Modifier program.

 

Leave a reply, ask a question or share information using the “Leave a Reply” section below, or email Sarah Leake directly with your questions or comments.

Read all previous posts

See Meaningful Use Blog

See MACRA-QPP Blog

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