Find-A-Code Focus Newsletter

How to Request a PQRS Informal Review

By Brandy Brimhall CPC CMCO CPCO CCCPC CPMA
November 23, 2015

As you know, the PQRS (Physician Quality Reporting System) includes the reporting of particular G codes to communicate with Medicare, details of the Functional Outcome Assessment and Pain Assessment and Follow-Up measures. These measures must be completed on at least 50% of an eligible professional's active patients to avoid penalty.

Recently, letters have been sent out to practices informing practices that they have not satisfactorily reported those PQRS measures and therefore, a negative payment adjustment (penalty) will be assessed from 2016 Medicare reimbursements.

If you have received one of these letters but do believe that you have satisfactorily reported PQRS through 2014, you must act now. Medicare allows a small window of time (until 11/23/2015) for practices to request an Informal Review in which your PQRS reporting for 2014 will be re-evaluated.

For instructions to request an informal review, please click here.


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