On September 18, the Centers for Medicare and Medicaid Services (CMS) announced the release of 2016 Physician Quality Reporting System (PQRS) Feedback Reports and 2016 Annual Quality and Resource Use Reports (QRURs).
The PQRS Feedback Reports show clinicians program year 2016 PQRS reporting results, including if they are subject to the 2018 PQRS downward payment adjustment. The 2016 Annual QRURs show how clinicians in groups and solo practitioners performed in 2016 on the quality and cost measures used to calculate the 2018 Value Modifier, as well as their practice’s 2018 Value Modifier payment adjustment.
The 2016 PQRS Feedback Report contains detailed information needed to determine a clinician’s program year 2016 PQRS reporting results and indicates if the clinician is subject to the 2018 PQRS downward payment adjustment. The 2016 Annual QRURs show how groups and solo practitioners performed on quality and cost measures relative to national benchmarks and indicate if the clinicians will receive an upward, neutral or downward Value Modifier adjustment to their payments for items and services rendered under the Medicare Physician Fee Schedule in 2018.
The Physician Quality Reporting System (PQRS), the Value Modifier Program, and the Medicare Electronic Health Record Incentive programs will sunset in 2018; these programs will be replaced by the Merit-based Incentive Payment System (MIPS) under the new Quality Payment Program (QPP). The QPP reduces quality reporting burden, and allows eligible clinicians the flexibility to pick their pace for participating in the first year; payments are based on the clinician’s performance with participating in the QPP. The first performance period of the QPP is January 1, 2017 through December 31, 2017, and the first payment adjustment year will be 2019.
If clinicians believe they were assessed the 2018 PQRS downward payment adjustment in error, they can submit an informal review request.
How to Access the Reports (from CMS):
- Enterprise Identity Management (EIDM) Account. An EIDM account with the appropriate role is required for participants to obtain 2016 PQRS Feedback Reports and 2016 Annual QRURs.
- If you already have an EIDM account, then follow the instructions provided here to sign up for the appropriate role in EIDM. To find out if there is already someone who can access your PQRS Feedback Report and QRUR, contact the QualityNet Help Desk.
- To sign up for an EIDM account, visit the CMS Enterprise Portal and click “New User Registration” under “Login to CMS Secure Portal.” Instructions for signing up for an EIDM account are provided here.
- Both reports can be accessed on the CMS Enterprise Portal using the same EIDM account. See the “Quick Reference Guide for Accessing 2016 PQRS Feedback Reports” or the “Quick
- Access Guide for 2016 PQRS Feedback Reports” for additional information. Both are available on the PQRS Analysis and Payment web page.
Visit the How to Obtain a QRUR webpage for instructions on accessing a 2016 Annual QRUR.
How to File an Informal Review (From CMS):
- If you believe you were assessed the 2018 PQRS downward payment adjustment in error, please submit an informal review request.
- For more information about the informal review process, view the “2016 Physician Quality Reporting System (PQRS): 2018 Downward Payment Adjustment - Informal Review Made Simple” guide on the PQRS Analysis and Payment webpage.
- For the 2018 Value Modifier, groups and solo practitioners may request an informal review of perceived errors in their 2018 Value Modifier calculation. Additional information about how to request an informal review is available on the 2016 QRUR and 2018 Value Modifier webpage.
- You may request an informal review of your 2016 PQRS results and/or 2018 Value Modifier calculation during the informal review period that will begin on September 18, 2017, and close on December 1, 2017 8:00 pm Eastern Time.
To prepare for success in the QPP, clinicians are encouraged to review their PQRS feedback report, annual QRUR and visit https://qpp.cms.gov to learn about the Quality Payment Program.