PQRS 2016 Informal Review Process

Individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, and group practices participating in GPRO (including ACOs) that did not satisfactorily report PQRS in 2014 will receive a negative payment adjustment in 2016. In addition, those individuals and groups will not receive a 2014 PQRS incentive payment.

If you believe that you have been incorrectly assessed the 2016 PQRS negative payment adjustment, you may request an informal CMS review of your incentive eligibility and/or payment adjustment determination.

Informal review requests must be submitted between September 9, 2015 and November 9, 2015.

Submit your request via the Quality Reporting Communication Support Page (CSP) which will be available 9/9/15
- 11/9/15 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. CMS has also published an overview of the process in Incentive Eligibility and 2016 Negative Payment Adjustment: Informal Review Made Simple.

Within 90 days of the original request, CMS will contact all informal review requestors via email with a final decision.

All decisions will be final and there will be no further review or appeal.

For additional questions regarding the informal review process, contact the QualityNet Help Desk:

• Monday – Friday: 8 am – 8 pm EST
• Phone: 1-866-288-8912 (TTY 1-877-715-6222)
• Fax: 888-329-7377
• Email: (To avoid security violations, do not include personal
identifying information such as SSN or TIN in e-mail inquiries.)