decisionhealth Newsletters, Coder Pink Sheets - 2016 Issue 12 (December)
Quality payment program: Don’t skimp on the details you send with your informal review request
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Article Overview
This article explains the informal review process associated with CMS quality reporting and the value-based modifier. It is aimed at practices and other providers reviewing quality and resource use reports, and it emphasizes the importance of submitting complete supporting details when disputing CMS determinations. The discussion focuses on the reporting context, the types of issues that may be raised, and why thorough documentation matters during review.
Why This Topic Matters
Practices that believe CMS has made an incorrect quality-related determination have a limited opportunity to request review, so understanding the process and what supporting information belongs in a request is important for maintaining accurate reporting outcomes.
What You Will Learn
- How the informal review process fits into CMS quality reporting workflows.
- What kinds of report issues may prompt a review request.
- Why supporting documentation and specificity matter in a review submission.
- Who is affected by quality report determinations and related review processes.
Who Should Read This
- Physician practices
- Billing and coding professionals
- Compliance staff
- Practice managers
- Healthcare consultants
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