This Week – August 13, 2016

This Week in Washington, D.C.

  • CMS Provides Guidance on PQRS Feedback Reports and the PQRS Informal Review Process for 2015 Results: What ACG members need to know

From ACG National Affairs Committee Chair Whitfield L. Knapple, MD, FACG

CMS Provides Guidance on PQRS Feedback Reports and the PQRS Informal Review Process for 2015 Results

What ACG members need to know

Each year, physicians and group practices receive “PQRS feedback reports” detailing whether they satisfactorily participated in PQRS, or whether they are subject to the future payment cuts.

CMS recently announced that these payment adjustment letters are anticipated to be sent later this summer.  CMS also provided further guidance described below.

Basic Background

PQRS applies a 2% payment cut to 2017 payments under the Medicare Physician Fee Schedule (MPFS) to individual eligible professionals (EPs) and PQRS group practices who did not satisfactorily report PQRS data in 2015.   Individual EPs and PQRS group practices must have met the criteria for satisfactorily reporting PQRS data in 2015 for covered professional services to avoid the negative payment adjustment in 2017 (2015 program participation affects payment adjustments in 2017).

Individual EPs are identified on claims by their individual National Provider Identifier (NPI) and Tax Identification Number (TIN).

Group practices participating in PQRS via the group practice reporting option (GPRO) are referred to as PQRS group practices and are identified by their TIN.

What’s in this feedback report & why is it important to me? Read the full blog