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January 11, 2016

Providers Receive Notice for PQRS Payment Adjustments

January 11, 2016

Medical Billing Services

The Centers for Medicare and Medicaid Services (CMS) operate something called the Physician Quality Reporting System, a quality reporting program that allows providers to submit information on quality of care to Medicare.

As a part of the program, CMS can institute a negative payment adjustment to any provider who doesn’t “satisfactorily report data on quality measures” per the standards of the program. This negative payment adjustment applies for the billing year two years later. For example, providers in 2016 will be penalized for not participating in the program in 2014.

Recently, a slate of notices went out to providers across the country from CMS in regards to not participating in PQRS in 2014. This adjustment for most is 2.0% of all Medicare Physician Fee Schedule (MPFS) payments given in the 2014 billing year. As a result, many anesthesia providers found themselves with their Medicare payments reduced by 2.0% for the upcoming year.

As a full service medical billing company Medical Business Management has submitted an appeal via the informal review process for our clients and providers.

Any anesthesia provider impacted by this adjustment can submit a request for an informal review for a limited time. The deadline is 60 days following the release of PQRS Feedback reports. Information on the informal review process can be found in the Payment Adjustment Toolkit on the CMS website.

You can also contact the QualityNet Help Desk at 1-866-288-8912 or by email at qnetsupport@hcquis.org.

For more information on PQRS Quality Reporting and solutions on how to become compliant please contact Medical Business Management.

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