Mark your calendar for Nov. 9!

October 26, 2015

Mark your calendar for Nov. 9!

The Advocacy Council (formerly JCAAI) wants to make you aware of the following announcements from CMS with an important upcoming deadline – Nov. 9, 2015. All three of the following issues may require you to take action before the Nov. 9 deadline!

  • QRURS – These reports indicate how your group or solo-practitioner performed in 2014 on quality and cost measures. These outcomes were used to calculate the 2016 Value Modifier. To obtain your report and get more information, see announcement below.
  • Value modifiers – For groups with 10 or more EPs that are subject to the 2016 Value Modifier, CMS established an Informal Review Period to request corrections of any perceived errors in their 2016 Value Modifier calculation. See announcement below for more information.
  • 2016 Negative Payment Adjustment and Review Process – The announcement below from CMS addresses negative payment adjustments for lack of satisfactory reporting of PQRS data in 2014. If you believe that there may be an incorrect penalty assigned to your Medicare reimbursement in 2016 because of “insufficient reporting,” you need to request an informal review. This request should be sent to CMS prior to Nov. 9, 2015 at 11:59 EST – see the CMS memo below for more details.

The period for requesting an informal review of the 2016 Value Modifier is open now and ends November 9, 2016.

The 2014 Annual Quality and Resource Use Reports (QRURs) are now available for every group practice and solo practitioner nationwide. Groups and solo practitioners are identified in the QRURs by their Taxpayer Identification Number (TIN). The QRURs are also available for groups and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model, or the Comprehensive Primary Care initiative in 2014, and to those TINs consisting only of non-physician eligible professional (EPs). 

The 2014 Annual QRURs show how groups and solo practitioners performed in 2014 on the quality and cost measures used to calculate the 2016 Value Modifier. For groups with 10 or more Eps that are subject to the 2016 Value Modifier, the QRUR shows how the Value Modifier will apply to physician payments under the Medicare Physician Fee Schedule (PFS) for physicians who bill under the group’s TIN in 2016. For all other groups and solo practitioners, the QRUR is for informational purposes only and will not affect their payments under the Medicare PFS in 2016.

Authorized representatives of group and solo practitioners can access the 2014 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. For more information on how to access the 2014 Annual QRURs, visit How to Obtain a QRUR.

For groups with 10 or more Eps that are subject to the 2016 Value Modifier, CMS established an Informal Review Period to request a correction of a perceived error in their 2016 Value Modifier calculation. These groups may request an informal review of their 2016 Value Modifier determination, now through November 9, 2015

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 or 888-734-6433 (select option 3).


2016 Negative Payment Adjustment and the Informal Review Process

In 2016, CMS will apply a negative payment adjustment to individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, and group practices participating in the Physician Quality Reporting System (PQRS) group practice reporting option (GPRO) (including Accountable Care Organizations [ACOs]) that did not satisfactorily report PQRS in 2014. Individuals and groups that receive the 2016 negative payment adjustment will not receive a 2014 PQRS incentive payment. 

EPs, CPC practice sites, PQRS group practices, and ACOs that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment may submit an informal review between September 9, 2015 and November 9, 2015 requesting CMS investigate incentive eligibility and/or payment adjustment determination. All informal review requestors will be contacted via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review. 

All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which will be available September 9, 2015 through November 9, 2015 at 11:59 p.m. Eastern Time. 

Please see 2014 Physician Quality Reporting System (PQRS): Incentive Eligibility & 2016 Negative Payment Adjustment – Informal Review Made Simple (available on the Analysis and Payment section of the PQRS website) 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 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 Taxpayer Identification Number (TIN), in e-mail inquiries to the QualityNet Help Desk.