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2016 PQRS Payment Adjustments Subject to Medicare Final Rule

Payment adjustments included in 2016 PQRS reports may change pending a final rule for Medicare payments in 2018.

CMS PQRS

Source: Thinkstock

By Kate Monica

- CMS recently announced feedback reports on the 2016 Physician Quality Reporting System (PQRS) and 2016 Annual Quality and Resource Use Reports (QRURS) containing information about performance and payment adjustments are now available.

However, PQRS payment adjustments shown in the report are based on proposals part of the 2018 Medicare Physician Fee Schedule Proposed Rule and are therefore potentially subject to change.

CMS clarified it will provide an update to report recipients if proposed policies are not finalized and the payment adjustments are consequently modified. Payment adjustments included in the reports are based on the following proposals: 

  • Reduce the automatic downward Value-Based Payment Modifier (Value Modifier) adjustment by half for practices that did not meet the minimum quality reporting requirements;
  • Hold all practices that met the minimum quality reporting requirements harmless from downward Value Modifier payment adjustments based on performance;
  • Reduce the maximum upward Value Modifier payment adjustment for performance for large practices to align with the adjustment for small and solo practices.
  • Reduce the number of measures that must be satisfactorily reported for the 2016 PQRS to avoid the 2018 downward payment adjustment from 9 measures across 3 National Quality Strategy domains to 6 measures with no domain requirement.  

CMS noted the majority of eligible professionals (EPs) successfully reported to PQRS for the 2016 reporting period. CMS also stated its expectations that providers will continue to succeed under the Quality Payment Program (QPP), which replaced PQRS in January of this year.

EPs that perceive their payment adjustment status is erroneous may request an informal review of their 2016 PQRS results or 2018 Value Modifier calculation any time before December 1, 2017 at 8pm. 

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