Assessments are complete, and the Centers for Medicare & Medicaid Services has determined which physician practices will face a pay cut – officially, a “downward payment adjustment” – for failing to comply with the Physician Quality Reporting System (PQRS). Doctors have just 2 months to challenge findings that they believe were made in error to spare themselves a cut in 2016.
The pay cut will apply to individual eligible practitioners and PQRS group practices that did not satisfactorily report data on quality measures in 2014. The 2% cut will be applied to all Part B covered services, according to a Sept. 9 CMS announcement.
To learn whether they are subject to the cut, physicians can review their 2014 PQRS feedback reports, which became available Sept. 8. The reports apply to doctors who submitted quality data in calendar year 2014. Feedback reports for 2015 will be available approximately this time next year.
To challenge PQRS determinations, physicians can submit an informal review between Sept. 9 and Nov. 9 and request that the CMS reevaluate incentive eligibility and adjustment determinations. Those requests can be made through the quality reporting portal. Physicians who request a review will be contacted via email of a final decision by the CMS within 90 days of their request. All decisions will be final and there will be no further review or appeal, according to the CMS.
It should not be surprising that physicians who did not satisfactorily comply with PQRS will see a 2% pay cut next year, said David Harlow, a health law and policy attorney based in Newton, Mass. What’s unusual, however, is that the informal review process does not include an avenue for an independent evaluation, Mr. Harlow said.
“It’s CMS reviewing a CMS decision,” he said in an interview. “From a provider perspective, there might be some skepticism about the independence of that review. CMS says this is not something that is subject to further administrative or judicial review. So there’s not an appeal.”
Mr. Harlow said that he would not be surprised if physician organizations advocate for further judicial relief in the process. CMS has previously provided avenues for administrative or judicial appeals of its decisions in other programs, he noted.
In its announcement, the agency outlined the ways in which physicians could have avoided the coming pay cut. This included reporting nine measures across three domains for 50% of Medicare patients, completing the GPRO Web Interface, or reporting at least one registry measures group for 20 patients, at least 11 of whom were Medicare Part B patients. Additionally, doctors could have reported three measures across one domain for 50% of Medicare patients, or satisfactorily participated in a qualified clinical data registry.
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