Request a Review of 2012 PQRS Participation Results

November 7, 2013

Centers for Medicare & Medicaid Services

Eligible professionals (EPs), designated support staff/vendors, and group practices who submitted data for the 2012 Physician Quality Reporting System (PQRS) program can now request to have an informal review of their 2012 PQRS reporting performance.

An informal review may be requested if the feedback report reveals that the EP or group practice did not earn the 2012 PQRS incentive payment when they believe they should have, or when they believe the payment amount was incorrect. Informal review requests will be accepted from November 1, 2013 through February 28, 2014.

The informal review will be for all 2012 reporting methods, including:

  • Claims
  • Qualified registry
  • Qualified EHR
  • Group Practice Reporting Option (GPRO) Web Interface (for groups of 100 or more EPs)

Steps to Request an Informal Review

In order to request an informal review of 2012 PQRS performance, CMS must receive a valid informal review request via the web-based tool, Quality Reporting Communication Support Page, during the informal review period. Please follow the steps below to submit a valid request:

  • Individual EPs or designated support staff will need to submit a request for an informal review for each individual rendering National Provider Identifier (NPI) for each Tax Identification Number (TIN) under which the requestor submitted 2012 PQRS QDCs or data.
  • Groups that participated in the GPRO will need to have their main point of contact request an informal review for the TIN under which the GPRO submitted 2012 PQRS QDCs or data.
  • To submit the request, go to the Communication Support Page between November 1, 2013 and February 28, 2014.
  • Complete the mandatory fields in the online form, including the appropriate justification, for the request to be deemed valid. Failure to complete the form in full will result in the inability to process the request. CMS or the QualityNet Help Desk may contact the requestor for additional information if necessary.

PQRS Resources

For more information about the informal review, see the 2012 PQRS Informal Review Made Simple fact sheet or visit the PQRS website. You can also learn about other eHealth initiatives at CMS by visiting the CMS eHealth website.