Nov. 9 Marks Deadline to Request Informal Quality Data Review

Medicare Initiatives Affect 2016 Payment

October 28, 2015 01:14 pm News Staff

A deadline is fast approaching that some family physicians literally can't afford to miss.

According to CMS' Oct. 22 MLN Connects Provider eNews( from the Medicare Learning Network, physicians have less than two weeks now to request that CMS take a second look at their practices' status with two Medicare initiatives that could affect how much they are paid in 2016.

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2016 Value-based Payment Modifier

CMS points out that physicians in groups with 10 or more eligible professionals that are subject to the 2016 value-based payment modifier (VBPM) have until Nov. 9 to request an informal review to determine if errors were made in the 2016 VBPM calculation for their practices.

Those calculations are based on Quality and Resource Use Reports (QRURs) that are distributed by CMS through its physician feedback program.

The AAFP strongly encourages family physicians to review their QRURs because the reports include practice performance information that is then compared to similar practice groups.

QRURs are intended to help physicians improve the quality of the care they provide to patients and to forecast how a practice will fare under the future value-based payment system.

To request an informal review of their VBPM calculation, physicians should consult the 2016 VM (value modifier) Informal Review Request Quick Reference Guide.(

Physician Quality Reporting System

In addition, some family physicians may face a Medicare payment penalty in 2016 associated with the Physician Quality Reporting System (PQRS).

Physicians who suspect they have incorrectly been assessed a negative payment adjustment -- or think they should receive a PQRS incentive payment -- also have until Nov. 9 to submit a request for an informal review of their practice stats.

According to CMS, physicians must submit all such requests electronically.(

Questions? Contact the QualityNet Help Desk by phone at 866-288-8912 or by email at The help desk is staffed 7 a.m. to 7 p.m. CT Monday through Friday.

Related AAFP News Coverage
Is Your Practice Making Progress With CMS Quality Initiatives?
Individual PQRS Dashboard Reports, QRURs Available for Review


Get the 4-1-1 on CMS' Proposed Value-based Modifier Payment
Successful PQRS Reporting in 2013 Can Avoid Penalties in 2015


Additional Resources
CMS 2014 Quality and Resource Use Reports(

CMS PQRS Fact Sheet(

CMS PQRS Payment Adjustment Toolkit(

CMS 2016 PQRS Payment Adjustment(

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