From now through December 16, 2015, physician anesthesiologists and other providers who believe they have received an incorrect assessment under PQRS or the Value Modifier program may request an informal review from CMS.
In 2016, the Centers for Medicare and Medicaid Services (CMS) will apply a negative payment adjustment to eligible professionals (EPs) who did not satisfactorily report PQRS in 2014. Additionally, groups with 10 or more eligible professionals (EPs) who did not satisfactorily report PQRS in 2014 may also be subject to the 2016 Value Modifier penalty.
To submit an informal review for an incorrect PQRS assessment, you must submit your request electronically via the CMS QualityNet webpage. In your request, please specify whether you want CMS to investigate incentive eligibility and/or payment adjustment determination. CMS has stated that all requestors will receive an email with a final decision within 90 days of the original request for informal review. These decisions will be final. If you have any questions about this process, you may also contact the QualityNet Help Desk atQnetsupport@hcqis.org or (866) 288-8912.
To submit an informal review of your 2016 Value Modifier determination, you must submit your request through the CMS Enterprise Portal. Additional information about the 2014 QRURs and how to request an informal review is available on the 2014 QRUR website and through the QRUR Help Desk at firstname.lastname@example.org or (888) 734-6433 (select option 3).
For basic information on PQRS and the Value Modifier, please visit the PQRS section of the ASA website.
For additional information, please contact the ASA Department of Quality and Regulatory Affairs (QRA) email@example.com, or (202) 289-2222.