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Is Your Practice in Danger of a Medicare Pay Cut?

Physicians that failed to comply with Physician Quality Reporting System (PQRS) requirements now face a 2% pay cut on all Medicare Part B covered services in 2016. This applies to individual eligible practitioners and PQRS group practices that did not satisfactorily report data on quality measures in 2014. Wondering if your practice is in that group? Physicians can review their 2014 PQRS feedback reports, which are available on the CMS physician value portal. There is a brief window (Sept. 9-Nov. 9) during which physicians can request that the CMS reevaluate incentive eligibility and adjustment determinations through an informal review process. Those requests can be made through the quality reporting portal and final decisions will be made within 90 days of requests. However, all decisions will be final and there will be no further review or appeal.

Future PQRS negative payment adjustments can be avoided. PQRS reporting mechanisms typically require an individual physician or PQRS group practice to report 9 or more measures covering at least 3 National Quality Strategy (NQS) domains. In addition, individuals or group practices are required to report one cross-cutting measure if they have at least one Medicare patient with a face-to-face encounter. This differs from the steps providers needed to take to avoid the 2016 negative payment adjustment. The CMS website has many helpful tools to guide physicians’ compliance.

Byline: Martha L. Sikes, MS, RPh, PA-C and Wendy Meltzer, MPH

Adapted from the official fact sheet.

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