PQRS: Submitting an Informal Review Request for PQRS/VM Adjustments
September 16, 2016
Written by Sarah Leake
The CMS Informal Review Request is a mechanism for providers and groups to request a review of negative payment adjustments for PQRS and the Value Modifier. This process allows individual Eligible Professionals, CPC practices, PQRS group practices and ACOs to request review of the payment adjustment determination.
When an informal review request is submitted, CMS will investigate whether a negative payment adjustment outcome was appropriate. Informal review decisions are final, and there will be no further review once a decision is determined.
There are two distinct processes to file an informal review request.
For the PQRS payment adjustment, informal review requests are submitted thru the Quality Reporting Communication Support Page (CSP) link in the LH Related Links box. This link is to be available sometime Fall 2016. Note: The Value Modifier Informal Review is not performed through this site.
For the Value Modifier adjustment, informal review requests are submitted via the CMS Enterprise Portal using the EIDM access.
Dates for informal review are typically 60 days in length, and they follow the release of the annual PQRS Feedback and Quality and Resource Utilization Reports (QRUR). The reports are usually released in the fall, and CMS has stated they will be out sometime in September 2016.
It is important to review the PQRS Feedback Reports and the QRUR before submitting an Informal Review Request. There is information in these reports that may help you understand why you received a negative adjustment and what information you will want to address in the informal review request.
More information can be found in this CMS presentation at Physician Quality Reporting System (PQRS) Feedback Reports and the PQRS Informal Review Process for Program Year 2015 Results – August 10, 2016
For detailed information about submitting an informal review request, please refer to the “2015 Physician Quality Reporting System (PQRS): 2017 Negative Payment Adjustment -Informal Review Made Simple” on the PQRS Payment Adjustment Information webpage.
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