Check PQRS, value modifier scores to assess, possibly dispute, 2018 payments

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article covers Medicare quality-reporting follow-up for physicians and group practices, focusing on how to review CMS feedback documents associated with prior-year reporting and how to dispute potential payment adjustments. It is relevant to practices that participated in PQRS, the value modifier program, and related CMS reporting tools, especially those wanting to understand whether their 2018 reimbursement may be affected. The piece also outlines the general CMS portals, reports, and review process used to check results and file an informal review.

Why This Topic Matters

The article helps readers determine whether older quality-reporting results could still affect Medicare payments and where to look for possible errors before the CMS review deadline. It is useful for practices trying to understand administrative steps around payment adjustments and dispute submission.

Article Sections

  1. Quality reporting

    Introduces the CMS quality-reporting context for prior performance years and the types of payment adjustments that may follow. It frames the article around physician and group-practice reporting programs and related Medicare reimbursement impacts.

  2. How to ascertain your 2018 outlook

    Describes how readers can access CMS reports and review their status for potential payment effects. It also covers the general process for checking documentation, identifying possible discrepancies, and preparing a dispute through CMS review channels.

What You Will Learn

  • How CMS quality-reporting results relate to later Medicare payment adjustments
  • Which CMS reports to review when checking for possible penalties
  • Where to find the general CMS portals and review resources referenced in the article
  • What the informal review process is used for in the context of reporting disputes
  • What kinds of documentation and deadline considerations are associated with filing a review

Who Should Read This

  • Physicians
  • Group practice administrators
  • Medical office managers
  • Quality reporting staff
  • Medicare billing and reimbursement professionals

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