Will You Receive PQRS, Value Modifier Payment Adjustments in 2018?
The Centers for Medicare and Medicaid Services (CMS) released the 2016 Physician Quality Reporting System (PQRS) Feedback Reports and 2016 Annual Quality and Resource Use Reports (QRURs) on September 18. Psychiatrists who view these reports can learn if their 2018 Medicare payments will be subject to payment adjustments. (Those getting PQRS adjustments should also receive a letter from CMS.) Each PQRS Feedback Report shows the reporting results for an individual psychiatrist, other eligible professional (EP), or group practice. This includes whether they were a “successful” PQRS reporter for 2016 or will receive a 2 percent downward payment adjustment in 2018.
Likewise, the 2016 Annual QRURs show how each psychiatrist, physician, nonphysician practitioner (physician assistant or advanced practice nurse), or group practice was rated in 2016 on the cost measures and quality tiering used to calculate the 2018 Value Modifier (VM). Each QRUR also indicates the practice’s 2018 VM payment adjustment, which can be a deduction or an addition.
2018 is the last year for PQRS and VM adjustments, and CMS has relaxed the evaluation standards, so it is hoped that few psychiatrists will be subject to these penalties. The new standards were part of the 2018 Medicare Physician Fee Schedule Final Rule.
How do you access PQRS Feedback Reports and QRURs?
An Enterprise Identify Management (EIDM) account is required for participants to obtain their 2016 PQRS Feedback Reports and 2016 Annual QRURs. Both reports can be accessed on the CMS Enterprise Portal using the same EIDM account. Visit the CMS hosted “How to Obtain a QRUR” webpage for instructions on accessing both reports. To find out which reports are available for your practice and your current and past PQRS and VM payment adjustments, you can use the new Payment Adjustments and Reports Lookup feature on the CMS Enterprise Portal. An EIDM account is not needed to use this feature. Instructions for using this feature are located in the “Guide for Accessing the Payment Adjustment and Reports Lookup Feature.”
CMS has provided resources to help you understand your PQRS Feedback Report and QRUR:
Should you learn that you are subject to the 2018 PQRS and/or VM downward payment adjustments, and you believe this was in error, you may request an informal review of your 2016 PQRS results and/or 2018 VM calculation. You must submit a request for informal review by 8 p.m. EST on December 1. Here is more information on how to do that.
APA members with additional questions can also contact Samantha Shugarman, Deputy Director of Quality, at sshugarman@psych.org. Also, APA has prepared a guide that provides additional information.
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