What is this CMS PQRS Notice I received?

Nathan Lyle

Many providers have recently received a notice from CMS. If you did not receive a letter, you will not be impacted by these changes. The letter is indicating that your practice has seen enough patients, and received enough funding from Medicare to qualify for the PQRS (Physician Quality Reporting System). PQRS is a reporting system that Medicare requires Physicians and other provider types to participate to receive funding. If your practice did not report or participate in submitting data in the 2016 year to PQRS, a 2% negative payment adjustment will be applied in 2018.

The letter goes on to talk about how 2018 reporting will work. The PQRS system is changing to the QPP (Quality Payment Program). This program is only used for certain provider types. In addition, the practice must serve over 100 patients and earn more than $30,000 in funding to be required to report. This program began January 1, 2017 and will be used for funding and reporting in 2019.


  • You can appeal the 2% reduction rate by asking for a review of your profile. Visit: https://qnpapp.qualitynet.org/pqrs/home.html, select Communication Support Page, select Informal Review Request, select PQRS Informal Review. This process is not guaranteed, and you may still be subject to the reduction, but you can indicate the reason as “thought provider type was exempt” or similar notes and see if the review is approved. Reviews must be submitted no later than December 1, 2017.
  • You can see now if you are required to report for the new QPP program. Visit https://qpp.cms.gov/, on the right-hand side of the page enter your NPI number for your group into the box and select the orange button that says check NPI. It will tell you if you are exempt or if you will need to report.

For more information on the letter and the changes please visit: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Payment-Adjustment-Information.html which is where this information was gathered from.