Dear CSWA Members,
You will start receiving your bonus for 2014 if you complied with PQRS that year shortly. If you did not comply, you will receive a notice of “negative payment adjustment” or a 2% decrease in Medicare payments for 2016 reimbursement.
If you believe you have complied and want to contest the payment adjustment, you may request a review from Medicare as follows:
EPs [eligible professionals, or LCSWs in private practice], CPC practice sites, PQRS group practices, and ACOs that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment may submit an informal review between September 9, 2015 and November 9, 2015 requesting CMS investigate incentive eligibility and/or payment adjustment determination. All informal review requestors will be contacted via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review or appeal.
All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which will be available September 9, 2015 through November 9, 2015 under the Related Links section of the Physician and Other Health Care Professionals Quality Reporting Portal.
Please see How to Request an Informal Review of 2014 PQRS Incentive Eligibility and 2016 PQRS Negative Payment Adjustment (available soon on the Analysis and Payment section of the PQRS website) for more information.
For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.orgMonday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. To avoid security violations, do not include personal identifying information, such as Social Security Number or Taxpayer Identification Number (TIN), in e-mail inquiries to the QualityNet Help Desk.
Let me know if you have any questions.
Laura W. Groshong, LICSW, Director, Policy and Practice
Clinical Social Work Association
lwgroshong@clinicalsocialworkassociation.org