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Accessing Your PQRS Feedback Report

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Update: PQRS feedback reports for program year 2015 are now available (via CMS, 9/26/16). 2017 PQRS negative payment adjustment letters will be distributed shortly. Informal review will be open until November 30, 2016 at 11:59 P.M. EST.

What is PQRS?
The Physician Quality Reporting System (PQRS) is a program established and managed by the Centers for Medicare and Medicaid Services (CMS). The federal initiative aims to incentivize the reporting of quality data by individual Eligible Professionals (EPs) and group practices to Medicare by tying it to reimbursement rates. As all individual EP’s and group practices likely know by now, failing to satisfactorily report PQRS data will result in a negative payment adjustment under the Medicare Physician Fee Schedule (PFS). Those who reported satisfactorily for program year 2015 will avoid the negative 2% payment adjustment in 2017.

When will PQRS feedback reports for program year 2015 be available?
CMS announced that the PQRS feedback reports for program year 2015 will be available sometime this month, September 2016. These reports indicate whether or not your practice met all reporting requirements and if you’ll be subject to the future negative payment adjustment. Additionally, CMS announced that payment adjustment letters are projected to be sent in late summer or early fall. We recommend reviewing your feedback report as soon as made available to ensure you have enough time to properly review and request an informal review should your organization determine there was an error or CMS incorrectly assessed your practice. (Check back for updates!)

How to access your PQRS Feedback Report
To access your PQRS feedback report, you will need an Enterprise Identity Management System (EIDM) account, which can be established using the CMS Enterprise Portal at https://portal.cms.gov. Once logged in, select the “PV-PQRS” tab and the “Feedback Reports” option to view your reports. The PQRS feedback can be viewed at three different levels: provider level, reporting mechanism level, and PQRS measure level. Detailed user guides can be found on the QualityNet portal page.

Quality Resource and Usage Reports
In addition to PQRS feedback reports, Quality and Resource Use Reports(QRURs) are also made available through the CMS Enterprise Portal. These reports show performance on all of the quality and cost measures at the Taxpayer Identification Number (TIN) level. These results are used by CMS to calculate the 2017 Medicare Value-Based Payment Modifier. CMS makes two types of QRURs available: the Mid-Year QRUR and the Annual QRUR. The Mid-Year QRUR (MY-QRURs) was made available in April 2016 and was for informational purposes only. Groups of 2 or more EPs and physicians who are subject to the 2017 Value-Based Payment Modifier can use the Annual QRUR to see how the value modifier will apply to the Medicare PFS physician payments. The QRUR is for informational purposes for all other groups and solo practitioners.

Requesting an informal review
If you believe that there was an error or a negative payment adjustment was applied incorrectly, you can request an informal review of the payment adjustment determination. If the review process concludes that satisfactory reporting actually occurred, CMS will reverse the application of the negative payment adjustment. Unfortunately, the informal review decision is final. CMS has no formal appeals process in place at this time.

To submit an informal review request, visit the Quality Reporting Communication Support Page (CSP). Informal review requests for 2015 may be submitted in the fall of 2016, and CMS will announce when this page is available. Remember, the informal review period is limited so review your feedback and get your requests in as soon as the page is available.

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