San Francisco Marin Medical Society Blog

Deadline for Informal Review of Potential Penalties Extended to 12/7

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Physicians who want to contest potential payment penalties associated with the Physician Quality Reporting System (PQRS) and/or the Value Modifier (VM) now have until December 7 to file a request for an informal review of their data.  Previously, the deadline to request a review was November 30 but the Centers for Medicare and Medicaid Services announced yesterday that the deadline will be extended by one week.

The penalties in question stem from policies in effect prior to the enactment of the Medicare Access and CHIP Reauthorization Act.  Failure to successfully complete required PQRS reporting will result in a 2% penalty.  Value Modifier penalties can range from 1% to 4% depending on the size of the practice and its performance on cost and quality measures.  PQRS penalties were communicated to physicians by mail as well as in the PQRS feedback reports posted on the CMS web site.  Value Modifier penalties and bonuses can be found in Quality and Resource Use Reports (QRURs) posted on the web site only.

Those who have questions, even if they are uncertain about penalty status, are urged to submit a request for informal review.  Although in most cases a successful PQRS review will trigger an automatic review of related VM penalties, program officials say the safest course is to file requests for review of both PQRS and VM data. 

To File A Request for PQRS Informal Review:

Go to the Quality Reporting Communication Support Page (CSP), select “related links” in communication support page in the upper left-hand corner, then select “informal review request” followed by “”PQRSs informal review” and fill out requested information when new page opens.

If you have not already done so, 2015 PQRS feedback reports can be accessed on the CMS Enterprise Portal using an Enterprise Identity Management (EIDM) account. See PQRS Analysis and Payment webpage 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 Qnetsupport@hcqis.org 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 TIN, in e-mail inquiries to the QualityNet Help Desk.

To File A Request for VM Informal Review:

For information on how to file, see the 2017 Value Modifier Informal Review Request Quick Reference Guide.

For more information, see: How to Obtain a Quality and Resource Use Report (QRUR) webpage and/or  2015 QRUR and 2017 Value Modifier webpage.

Help Desk Information: For EIDM, contact the QualityNet Help Desk at qnetsupport@hcqis.org or 866-288-8912 (TTY 877-715- 6222);  For QRURs or the Value Modifier, contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 3)