decisionhealth Newsletters, Part B News - 2016 Issue 11 (November)
Don’t skimp on the details you send with an informal review request
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Article Overview
This article covers CMS informal review requests related to physician quality reporting and the value-based modifier. It is aimed at practices and providers that want to understand the review process, the deadline to request review, and the kinds of supporting details that help CMS understand a dispute. The discussion focuses on the general scope of the review, the types of reporting issues involved, and the importance of submitting complete information.
Why This Topic Matters
For practices facing a possible quality-related payment adjustment, understanding the informal review process can affect whether CMS’s determination is successfully challenged. The article helps readers identify the type of information CMS expects in a review request and why completeness matters.
Article Sections
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Quality reporting
Overview of informal review requests tied to physician quality reporting and the value-based modifier. The section discusses the need to identify disputed findings and provide supporting context for CMS review.
What You Will Learn
- How the informal review process is described in relation to CMS quality reporting
- What kinds of supporting details practices are expected to provide with a review request
- Why completeness and specificity matter when disputing CMS findings
- The general categories of reporting issues that may be raised in an informal review
Who Should Read This
- Physician practices
- Healthcare administrators
- Medical coders
- Practice managers
- Compliance staff
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