If you submitted data to Medicare’s Physician Quality Reporting System (PQRS) for the 2015 program year, now is the time to review your quality reports. Unfortunately the deadline to appeal has passed. However it is still a good idea to review your report.
Among other information, the reports tell you whether you are subject to a PQRS penalty and/or a value modifier (VM) payment adjustment. These will apply to your Medicare payments in 2017.
If you didn’t submit PQRS data, or submitted unsuccessfully, in 2015, you’ll receive:
- An automatic 2-percent PQRS penalty in 2017, AND
- An automatic VM penalty in 2017: 2 percent for solo and small groups or 4 percent for groups of 10 or more.
If you submitted PQRS data successfully in 2015, CMS used your quality and cost data to determine your VM quality tier designation (high, average, or low) and thus your VM payment adjustment:
- High: Solo and groups of two to nine clinicians will receive an upward adjustment, or bonus, of 1.0x to 2.0x (where “x” represents the adjustment factor). Groups of 10 or more will receive a bonus of 2.0x to 4.0x.
- Average: You’ll receive no payment adjustment.
- Low: In 2017, solo and small groups will be held harmless from a downward VM adjustment, or penalty. For groups of 10 or more, the VM penalty is 2.0x to 4.0x..