The final payment adjustment under the Value Modifier (VM) and corresponding Physician Quality Reporting System (PQRS) is underway. On Sept. 18, 2017, CMS released the 2016 PQRS feedback reports and 2016 Annual Quality and Resource Use Reports (QRURs). The 2016 PQRS feedback reports indicate whether clinicians will be subject to a 2018 PQRS downward payment adjustment, while the 2016 QRURs show whether clinicians will receive a 2018 VM penalty.
Importantly, PQRS and VM penalties are scheduled to be less severe because they are based on proposals set forth by the 2018 Physician Fee Schedule Proposed Rule. If the proposals are accepted, a 2% PQRS penalty and a VM penalty could be avoided by having reported 6 measures (instead of 9) in 2016 that crossed at least 3 domains and included 1 cross-cutting measure. The proposal also would halve VM penalties and bonuses, with penalties falling from a maximum of 2% to 1% for smaller practices. The available feedback reports currently reflect the proposed rule.
The AASM recommends that physicians take the following steps to avoid potential financial penalties:
- Access both your PQRS feedback report and QRUR at the How to Obtain a QRUR page. Note: you will need to set up an Enterprise Identify Management System (EIDM) account first.
- Review the reports and make sure that adjustments are based on the reduced requirements established by the 2018 Physician Fee Schedule Proposed Rule.
- If you find that they are uncertain about your financial penalty status through this process, request an informal review of both PQRS and VM data. Refer to the 2016 PQRS: 2018 Downward Payment Adjustment – Informal Review Made Simple Guide and the 2018 Value Modifier Informal Review Request Quick Reference Guide to initiate reviews.
For more information about Medicare reimbursement for sleep medicine care, please visit the AASM’s Medicare Resources page.