CMS extends deadline for QRUR informal reviews

Physicians who have not yet requested an informal review of their Quality and Resource Use Reports (QRURs) are getting more time.

The Centers for Medicare & Medicaid Services (CMS) has extended the deadline to request a review of the QRUR, which is a key piece of both the Physician Quality Reporting System (PQRS) and the Value-Based Payment Modifier (VBPM). Eligible professionals (EPs) now have until 11:59 Eastern Time on Nov. 23 to request an informal review. Under the VBPM, groups of 10 or more EPs can request a review if they feel their 2016 value modifier was incorrectly calculated. Under PQRS, EPs can request a review if they feel they have been assigned a penalty erroneously.

The 2014 QRURs were released in September and contain performance information related to the quality and cost measures used to calculate the 2016 VBPM. The reports also indicate if a provider satisfactorily reported under PQRS for 2014. A provider who did not satisfactorily report should have received a letter from CMS last month indicating that they will receive a 2 percent cut in all of their 2016 Medicare physician fee schedule payments.

CMS allows a 60-day review period of QRURs; however, CMS announced on Oct. 30 that it was granting a two-week extension. Providers can contact the Physician Value Help Desk (1-888-734-6433 option 3 or pvhelpdesk@cms.hhs.gov) for additional information on how to request an informal review. It is important for providers to note that the result of the informal review is final and cannot be appealed. CMS submits its final decision by email within 90 days of the request.

In addition, look for an article on QRURs in the November/December issue of Family Practice Management.

– Erin Solis, Regulatory Compliance Strategist for the American Academy of Family Physicians

Posted on Nov 06, 2015 by David Twiddy