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PQRS Negative Payment Letters Sent

Dec 17, 2014

The Centers for Medicare and Medicaid Services (“CMS”) recently sent letters to group practices and eligible professionals (“EPs”) who did not satisfactorily report PQRS quality data measures in 2013 and will receive a negative 1.5% payment adjustment on their Medicare Part B payments starting Jan. 1, 2015. 

PQRS, the Physician Quality Reporting System, is a program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information.  Calendar year 2015 will be the first in which a negative impact is noticed.  In 2016, the negative adjustment will be 2% of the allowed fee schedule.

PQRS has also offered incentives for participation, but these incentives are diminishing as the penalties are implemented.  Groups and EPs who believe they are inappropriately penalized have the option of appealing with CMS through an informal review process by Feb. 28, 2015. There’s more information on how to file for an informal review here.

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Nancy Clark

Nancy Clark is a Senior Manager in the Health Care Consulting Group. Her expertise focuses on coding and documentation audits, which includes chart review and report compilation.

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