decisionhealth Newsletters, Part B News - 2015 Issue 9 (September)
PQRS informal review period starts, but hardship exemptions no longer available
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Article Overview
This article covers the CMS informal review period tied to Physician Quality Reporting System (PQRS) reporting data and payment adjustments. It is aimed at providers, group practices, and coding or compliance staff who need to understand when a review request may be appropriate, what general reporting context applies, and how CMS handles review decisions and deadlines. The discussion also touches on broader PQRS reporting expectations, the difference between individual and group reporting, and the kinds of data issues that can affect penalty or incentive outcomes.
Why This Topic Matters
PQRS reporting results could affect Medicare payment adjustments, so practices needed a clear understanding of the review window, the general reporting framework, and the types of data issues that may prompt a request for CMS review.
Article Sections
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PQRS informal review overview
Introduces the CMS informal review process for PQRS reporting data and explains who may consider requesting a review. It also notes the overall payment-adjustment context and timing described in the article.
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How to request the review
Summarizes the general online request process and the stated review window. This section also references the CMS communication path used to access the request form.
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CMS review outcome and notices
Describes the decision timeline, finality of the review, and the type of CMS notice sent to affected providers and group practices. It also distinguishes between group reporting and individual reporting within a group.
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Check that you met requirements
Reviews the broad PQRS reporting background needed to understand why an informal review might matter. It covers general reporting formats and the article’s discussion of compliance verification.
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2 informal review scenarios
Provides general examples of reporting-data situations discussed in the article that may be considered during review. The section focuses on the kinds of data discrepancies or volume issues that can affect results.
What You Will Learn
- How the CMS informal review process is positioned within PQRS reporting.
- What general timing and access steps are associated with requesting a review.
- How reporting method and data quality can affect PQRS payment outcomes.
- What broad categories of reporting issues are discussed as review scenarios.
Who Should Read This
- Physicians and eligible professionals
- Group practices
- Medical billing and coding staff
- Practice administrators
- Compliance staff
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