News & Press: Quality Improvement

U.S. 2015 Medicare Quality and Resource Utilization Reports to be Made Available

Tuesday, September 20, 2016  
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U.S. Centers for Medicare and Medicaid Services (CMS)  2015 Physician Quality Reporting System (PQRS) feedback reports will be available in September 2016 for individual eligible professionals (EPs) and PQRS group practices. The PQRS feedback reports will provide the final determination on whether or not participants met the PQRS criteria for avoiding the 2017 PQRS negative payment adjustment. Detailed information about the quality data submitted by the provider is also included. The 2015 Annual Quality and Resource Use Reports (QRURs) will also be available in September 2016 for all groups with 2 or more EPs and solo practitioners nationwide.

A PQRS feedback report will be generated for each Taxpayer Identification Number/National Provider Identifier (TIN/NPI) combination that reported PQRS data or that submitted Medicare PFS claims that included denominator-eligible events but did not submit PQRS data. The feedback reports will include all measures reported by the NPI for each submission mechanism used. The data in these reports may help an individual EP or PQRS group practice determine whether or not it is necessary to submit an informal review request. Detailed submission information for PQRS group practices that submitted via the GPRO Web Interface will be available in the Annual QRURs.

Additional information about the 2015 PQRS feedback reports and how to request an informal review will be available on the PQRS website and through the CMS QualityNet Help Desk at 1-866-288-8912 or qnetsupport@hcqis.org.

The 2015 Annual QRURs show how groups and solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier. For physicians in groups with 2 or more EPs and physician solo practitioners that are subject to the 2017 Value Modifier, the QRUR shows how the Value Modifier will apply to physician payments under the Medicare PFS for physicians who bill under the TIN in 2017. Groups and solo practitioners are identified in the QRURs by their TIN.

Authorized representatives of groups and solo practitioners can access the 2015 PQRS feedback reports and 2015 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. For more information on how to access these reports, visit How to Obtain a QRUR.

For groups and solo practitioners that are subject to the 2017 Value Modifier, CMS established an informal review period to request corrections of perceived errors in the 2017 Value Modifier calculation.

Additional information about the 2015 Annual QRURs and how to request an informal review is available on the 2015 QRUR and 2017 Value Modifier website and through the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 3).


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