Six days left to contest 2016 PQRS and VBPM penalties; Revised 2014 QRURs issued

Originally published in the November 18, 2015 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

Practices that wish to contest 2016 PQRS and/or Value-Based Payment Modifier (VBPM) penalties have until Monday, Nov. 23 at 11:59PM EST to file an informal review with the Centers for Medicare & Medicaid Services (CMS). Groups and providers can learn what their 2016 payment adjustments will be by reviewing their 2014 Quality and Resource Use Reports (QRURs).

Since QRURs were released earlier this fall, CMS has discovered numerous errors in the 2014 data submitted by qualified clinical data registries and EHR vendors that may impact VBPM calculations. More recently, CMS identified errors with the data used to calculate claims-based measures under the VBPM and issued revised QRURs that include recalculated VBPM payment adjustments to affected groups.

Groups and providers are strongly encouraged to review their 2014 QRURs and consider appealing any perceived errors in their PQRS and/or VBPM calculations. Groups and providers will not be able to appeal their 2016 payment adjustments after the informal review deadline has closed.

For information on how to file an informal review, view CMS’ reference guide.

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