2017 Payment Penalties: Know What to Expect

File for an Informal Data Review by November 30

Last month, CMS announced that physicians can consult to determine whether they will be subject to 2017 payment penalties that stem from policies in effect prior to the enactment of MACRA. Practices that have concerns about the findings in their reports are urged to file for an informal review of both PQRS and Value Modifier data by November 30.

Physician Quality Reporting System (PQRS) Penalties:

• Failure to complete required PQRS reporting will result in a 2% penalty.
• PQRS penalties will be communicated to physicians by mail as well as in the PQRS feedback reports posted on the CMS website.
• Click here for more information on accessing PQRS reports and filing for an informal review.

Value Modifier Penalties:

• Value Modifier penalties can range from 1% to 4% depending on the size of the practice and its performance on cost and quality measures.
• Value Modifier penalties and bonuses can be found in Quality and Resource Use Reports (QRURs) posted on the website only.
• Click here for more information on accessing Value Modifier reports and filing for an informal review.

Those who have questions, even if they are uncertain about penalty status, are urged to submit a request for informal review.  Although in most cases a successful PQRS review will trigger an automatic review of related VM penalties, program officials say the safest course is to file requests for review of both PQRS and VM data.