decisionhealth Newsletters, Part B News - 2010 Issue 8 (August)
Your 3-step PQRI appeals process
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Article Overview
This piece covers a proposed Medicare Physician Fee Schedule change affecting the Physician Quality Reporting Initiative and describes the basic outline of an informal review process for denied incentive bonuses. It is relevant to clinicians, coding and billing staff, and practice administrators who follow CMS reporting programs and want to understand the administrative review process and timing involved.
Why This Topic Matters
Practices participating in PQRI needed to understand how to challenge a bonus denial and what the proposed review pathway would look like. The article helps readers assess whether their reporting concerns fit the informal appeals process and the deadlines tied to feedback reports.
Article Sections
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Proposed PQRI appeal process
Introduces the CMS proposal to add an informal review path for disputed PQRI bonus determinations through the Quality Net Help Desk.
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How to request a review
Summarizes the general steps for submitting a review request, including the basic timing and the type of information the request should address.
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Response and finality
Describes the expected response timeframe and the article's discussion of the review process ending after the help desk decision.
What You Will Learn
- The general structure of the proposed PQRI appeal process
- Which CMS support channel is used for the informal review
- The timing framework associated with requesting a review
- What kinds of information a review request may include
- How the process ends after a help desk determination
Who Should Read This
- Physician practices
- Medical billers and coders
- Practice administrators
- Quality reporting staff
- Compliance staff
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