The Centers for Medicare & Medicaid Services (CMS) began notifying eligible providers (EPs) affected by a negative payment adjustment of 1.5 percent in 2015 for not meeting the requirements of successfully reporting in 2013 to the Physician Quality Reporting System (PQRS).

Obtaining a Feedback Report
Individual EPs and group practices that submitted 2013 PQRS data should retrieve their 2013 Feedback Reports through one of the following methods:

• National Provider Identifier (NPI)-level reports: Request these through CMS’ Communication Support Page by creating a NPI-level feedback report request. The report will be sent electronically to the email address provided in the request within two to four weeks.
• Taxpayer Identification Number (TIN)-level reports: Download these reports, which contain NPI level detail, from the Physician and Other Health Care Professionals Quality Reporting Portal. You must have an Individuals Authorized to Access CMS Computer Services (IACS) account. Review the IACS Quick References Guides to determine how to request one.
• 2013 Quality and Resource Use Reports (QRURs): Group practices that participated in the 2013 PQRS Group Practice Reporting Option (GPRO) can access PQRS feedback the 2013 QRURs. These can be accessed by authorized representatives of groups and solo practitioners at https://portal.cms.gov using a valid IACS User ID and password. For more information on the QRURs and Value Modifier, please access the Physician Feedback Program/Value-Based Modifier website.

Appealing a PQRS Negative Payment Adjustment
For those EPs who think the 1.5 percent payment adjustment is being applied in error, CMS has established an informal review process. Please keep the following in mind when considering this process:

1. You can request an informal review during the official time period starting Jan. 1, 2015, through Feb. 28, 2015. All requests must be submitted electronically through the Communication Support Page.
2. The appeals process is only for the 2013 PQRS reporting period from Jan. 1, 2013, through Dec. 31, 2013. It does not include ePrescribing, value-based payment modifier or Medicare EHR Incentive Program (Meaningful Use) reporting periods.

If an appeal is submitted, CMS will notify you by email that your review request has been received and will be processed. You will be notified with the decision, again by email, within 90 days of submission.

Important: Please note all appeals decisions are final. There is not a second level appeal process. CMS created this Informal Review Made Simple document for those interested in learning more about the steps involved in an informal review process.

Consider Appealing Your Payment Adjustment
IF…

• your organization is a Federally Qualified Health Clinic;
• your organization is a Rural Health Center;
• the NPI/TIN combination contained within the letter is incorrect;
• you submitted one measure on one claim during 2013; and/or
• you participated using the Administrative Claims-based mechanism.

Need further assistance? Contact atom Alliance:
Alabama: Lee Pearce
Indiana: Don Gettinger
Kentucky: Margie Banse
Mississippi: Ramona Drake or Dale Bridges
Tennessee: Erik Ervin