The 2015 Physician Quality Reporting System (PQRS) feedback reports will be available in September 2016 for individual eligible professionals (EPs) and PQRS group practices. The PQRS feedback reports will provide the final determination on whether or not participants met the PQRS criteria for avoiding the 2017 PQRS negative payment adjustment. Detailed information about the quality data submitted by the provider is also included.
The 2015 PQRS feedback reports reflect data from the Medicare Physician Fee Schedule (PFS) claims received with dates of service from January 1, 2015 – December 31, 2015 that were processed into the National Claims History (NCH) by February 26, 2016. A PQRS feedback report will be generated for each Taxpayer Identification Number/National Provider Identifier (TIN/NPI) combination that reported PQRS data or that submitted Medicare PFS claims that included denominator-eligible events but did not submit PQRS data. The feedback reports will include all measures reported by the NPI for each submission mechanism used. The data in these reports may help an individual EP or PQRS group practice determine whether or not it is necessary to submit an informal review request. Detailed submission information for PQRS group practices that submitted via the GPRO Web Interface will be available in the Quality and Resource Use Reports (QRURs).
Additional information about the 2015 PQRS feedback reports and how to request an informal review will be available on the PQRS website and through the QualityNet Help Desk at 1-866-288-8912 or firstname.lastname@example.org.
The 2015 Annual Quality and Resource Use Reports (QRURs) will also be available in September 2016 for groups with 2 or more EPs and solo practitioners. Groups and solo practitioners are identified in the QRURs by their TIN. The QRURs are also available for groups and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model, or the Comprehensive Primary Care initiative in 2015, and to those TINs consisting only of non-physician EPs.
The 2015 Annual QRURs show how groups and solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier. For physicians in groups with 2 or more EPs and physician solo practitioners that are subject to the 2017 Value Modifier, the QRUR shows how the Value Modifier will apply to physician payments under the Medicare PFS for physicians who bill under the TIN in 2017. For all other groups and solo practitioners, the QRUR is for informational purposes only and will not affect their payments under the Medicare PFS in 2017.
Authorized representatives of groups and solo practitioners can access the 2015 PQRS feedback reports and 2015 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. For more information on how to access these reports, visit How to Obtain a QRUR.
For groups and solo practitioners that are subject to the 2017 Value Modifier, CMS established an Informal Review Period to request corrections of perceived errors in the 2017 Value Modifier calculation.
Additional information about the 2015 Annual QRURs and how to request an informal review is available on the 2015 QRUR website and through the QRUR Help Desk at email@example.com or 888-734-6433 (select option 3).