Informal review of quality cuts may require a Hail Mary pass

by: Julia Kyles, CPC-A Nov 19, 2015

If you’ve had trouble accessing your practice’s quality resources and use report (QRUR), you’re not alone. Part B News has received multiple reports from readers who have had trouble getting into the physician portal where the reports are located, or once in, downloading the report.

But one reader isn’t letting that stop her from submitting informal review requests (IRR). It may be a Hail Mary pass, but it makes sense. The practice has received a notice that it will receive the 2% cut, and the informal review is its only chance to contest the cut.

You have until Nov. 23 at 11:59 p.m. EST to submit an informal review request. The process may be used by practices that believe that CMS improperly applied the 2% pay cut, or denied the 0.5% incentive payment, and to contest value-based modifier cuts.

Here are four tips to meeting the deadline:

Get on the right page. The informal review portal is located on CMS’s quality net page. It is under Communication Support Page, the last selection in the drop-down list on the left.
Allow yourself enough time. You must enter an IRR for each eligible provider in your practice and the pages will time out if it is idle for too long.
Complete the correct IRR. There is an IRR for PQRS and another for the value based modifier. Remember that if your practice had less than 10 eligible providers in 2014, it was not subject to the modifier cut, even though CMS did provide performance information to these groups.
Don’t leave the rationale blank. You can’t submit attachments with an IRR, but complete the rationale section. One consultant tells us that people who fill out that section have not received an automatic reply stating they didn’t make the grade.

Blog Tags: PQRS, Value-based modifier

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